May cause tardive dyskinesia (TD); d/c if signs/symptoms of TD develop. Avoid use for >12 weeks of therapy unless benefit outweighs risk.
(PO) Short-term therapy (4-12 weeks) for adults with symptomatic, documented gastroesophageal reflux disease (GERD) who fail to respond to conventional therapy. (PO, Inj) Relief of symptoms associated with acute and recurrent diabetic gastric stasis in adults. (Inj) Prevention of postoperative N/V (PONV) or chemotherapy-induced N/V. Facilitates small bowel intubation in adults and pediatric patients in whom the tube does not pass the pylorus with conventional maneuvers. Stimulates gastric emptying and intestinal transit of barium in cases where delayed emptying interferes with radiological examination of the stomach and/or small intestine.
Gastroesophageal Reflux Disease
10-15mg up to qid 30 min ac and hs
Single doses up to 20mg prior to the provoking situation
Therapy should not exceed 12 weeks in duration
10mg 30 min ac and hs for 2-8 weeks
10mg IV over 1-2 min for up to 10 days, then initiate oral administration
Initial route of administration should be determined by the severity of the presenting symptoms
10mg or 20mg IM near end of surgery
IV infused over at least 15 min, 30 min before chemotherapy and repeated q2h for two doses, then q3h for 3 doses
Initial Two Doses:
Highly Emetogenic Drugs (eg, Cisplatin, Dacarbazine): 2mg/kg
Less Emetogenic Regimens: 1mg/kg
Small Bowel Intubation
10mg single dose (undiluted) IV over 1-2 min if the tube has not passed the pylorus w/ conventional maneuvers in 10 min
Aid in Radiological Exam
When Delayed Gastric Emptying Interferes w/ Examination of the Stomach/Small Intestine:
10mg single dose (undiluted) IV over 1-2 min
Small Bowel Intubation
Administer as a single dose (undiluted) IV over 1-2 min if the tube has not passed the pylorus w/ conventional maneuvers in 10 min
<6 Years: 0.1mg/kg
6-14 Years: 2.5-5mg
>14 Years: 10mg
Initial: 1/2 the recommended dose; adjust dose as appropriate
Acute Dystonic Reactions: Inject 50mg diphenhydramine IM
Oral, IV/IM route
Doses >10mg: Dilute in 50mL of a parenteral sol; preferred sol is normal saline
Refer to PI for Admixture Compatibilities
Inj (Reglan): 5mg/mL [2mL, 10mL, 30mL]; Sol: 5mg/5mL [473mL]; Tab (Reglan): 5mg, 10mg* *scored
When GI motility stimulation is dangerous (eg, GI hemorrhage, mechanical obstruction, perforation), pheochromocytoma, epilepsy, and concomitant drugs that cause extrapyramidal symptoms (EPS).
Mental depression may occur; caution with prior history of depression. EPS, primarily as acute dystonic reactions, may occur. May cause parkinsonian-like symptoms; caution with preexisting Parkinson's disease. May suppress signs of TD; do not use for symptomatic control of TD. Neuroleptic malignant syndrome reported; d/c, monitor, and institute intensive symptomatic treatment. Risk of developing fluid retention and volume overload, especially in patients with cirrhosis or CHF; d/c if these occur. Caution with HTN, renal impairment, and/or in elderly. May increase risk of developing methemoglobinemia and/or sulfhemoglobinemia with NADH-cytochrome b5 reductase deficiency. May experience withdrawal symptoms after discontinuation. (Inj) Undiluted IV inj should be given slowly since rapid administration may cause anxiety, restlessness, and drowsiness. May increase pressure on suture lines after a gut anastomosis or closure; use caution with PONV.
TD, restlessness, drowsiness, fatigue, lassitude.
See Contraindications. GI motility effect antagonized by anticholinergics and narcotic analgesics. Additive sedation with alcohol, sedatives, hypnotics, narcotics, or tranquilizers. Caution with MAOIs. May diminish absorption of drugs from stomach (eg, digoxin) and increase rate and/or extent of absorption of drugs from small bowel (eg, acetaminophen, tetracycline, levodopa, ethanol, cyclosporine). Insulin dose or timing of dose may require adjustment. Rare cases of hepatotoxicity reported with drugs with hepatotoxic potential. Inhibits central and peripheral effects of apomorphine.
PREGNANCY AND LACTATION
Category B, caution in nursing.
MECHANISM OF ACTION
Dopamine antagonist/prokinetic; not established. Appears to sensitize tissues to the action of acetylcholine; stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions and accelerates gastric emptying and intestinal transit. Also increases resting tone of the lower esophageal sphincter. Antiemetic; antagonizes central and peripheral dopamine receptors, thereby blocking stimulation of chemoreceptor trigger zone.
Absorption: Rapid and well-absorbed; (PO) absolute bioavailability (80%); (PO) Tmax=1-2 hrs; IV administration in pediatrics resulted in varying parameters. Distribution: Plasma protein binding (30%); Vd=3.5L/kg; found in breast milk. Elimination: (PO) Urine (85%; 50% free or conjugated); T1/2=5-6 hrs.
Assess for conditions when GI motility stimulation is dangerous, pheochromocytoma, epilepsy, sensitivity or tolerance to the drug, CHF, cirrhosis, history of depression, Parkinson's disease, HTN, NADH-cytochrome b5 reductase and G6PD deficiency, diabetes mellitus, renal impairment, pregnancy/nursing status, and possible drug interactions.
Monitor for signs/symptoms of depression, EPS, parkinsonian-like symptoms, TD, NMS, HTN, fluid retention/volume overload, withdrawal symptoms, hypersensitivity reactions, and other adverse reactions.
Inform that drug may impair mental and physical abilities; advise to use caution while operating machinery/driving. Discuss the risks and benefits of treatment.
20-25°C (68-77°F). (Inj) If diluted with NaCl, may be stored frozen for up to 4 weeks. Diluted sol may be stored up to 48 hrs (without freezing) if protected from light; 24 hrs in normal lighting conditions.
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