Reglan (metoclopramide hydrochloride) is a prescription medication designed to accelerate gastric emptying and enhance coordination in the upper gastrointestinal tract. It is primarily indicated for the short-term treatment of adults with diabetic gastroparesis and for the relief of heartburn associated with gastroesophageal reflux disease (GERD) when conventional therapies have proven inadequate. By increasing muscle contractions in the upper digestive system, Reglan facilitates the movement of food through the stomach and intestines, providing symptomatic relief and improving overall digestive function. Its mechanism of action targets specific dopamine receptors, which helps regulate nausea, vomiting, and delayed gastric emptying. Proper usage under medical supervision is essential to maximize benefits and minimize potential risks.

Features

• Active ingredient: Metoclopramide hydrochloride
• Available in 5 mg and 10 mg tablet strengths
• Also supplied as an oral solution and injectable formulation
• Functions as a dopamine D2 receptor antagonist and serotonin 5-HT4 receptor agonist
• Promotes motility in the upper gastrointestinal tract
• Onset of action typically within 30 to 60 minutes after oral administration

Benefits

• Accelerates gastric emptying, reducing feelings of fullness and discomfort
• Alleviates persistent nausea and vomiting associated with gastroparesis
• Provides relief from severe, refractory heartburn in GERD patients
• Enhances the effectiveness of other oral medications by improving absorption
• Supports better nutritional intake and quality of life for those with chronic digestive issues
• Can be used adjunctively in radiographic procedures to improve visualization

Common use

Reglan is commonly prescribed for the short-term management (typically 4 to 12 weeks) of symptomatic diabetic gastroparesis, a condition where the stomach empties slower than normal, leading to bloating, nausea, and early satiety. It is also utilized for the treatment of gastroesophageal reflux disease that has not responded adequately to other therapies, helping to reduce the frequency and severity of heartburn episodes. In some clinical settings, it may be administered to prevent nausea and vomiting postoperatively or following chemotherapy, though this is off-label. Additionally, Reglan is sometimes used to facilitate small bowel intubation and to stimulate gastric emptying before certain radiological examinations.

Dosage and direction

For adults with diabetic gastroparesis, the usual dosage is 10 mg taken orally 30 minutes before each meal and at bedtime, for up to 12 weeks. Treatment duration should not exceed 12 weeks due to the risk of tardive dyskinesia. For GERD, the typical dose is 10 to 15 mg orally up to four times daily, 30 minutes before meals and at bedtime. Dosage adjustments are necessary for patients with renal impairment or those who are poor CYP2D6 metabolizers. The oral solution should be measured with a calibrated device to ensure accuracy. Injectable forms are administered intramuscularly or intravenously under medical supervision, with dosing based on specific clinical indications. Always follow the prescribing physician’s instructions precisely.

Precautions

Patients should be monitored for extrapyramidal symptoms, such as involuntary movements or muscle stiffness, which may occur even at recommended doses. Use with caution in individuals with depression, as metoclopramide can exacerbate symptoms. There is an increased risk of neuroleptic malignant syndrome, though rare; discontinue immediately if hyperpyrexia, altered mental status, or autonomic instability occurs. Reglan may cause drowsiness or dizziness—avoid driving or operating machinery until response is known. Fluid balance should be monitored, as the drug can lead to fluid retention. Periodic reassessment of the need for continued therapy is advised to minimize long-term risks.

Contraindications

Reglan is contraindicated in patients with a known hypersensitivity to metoclopramide or any component of the formulation. It should not be used when stimulation of gastrointestinal motility might be dangerous, such as in cases of gastrointestinal hemorrhage, mechanical obstruction, or perforation. Use is also contraindicated in patients with pheochromocytoma due to the risk of hypertensive crisis, and in those with epilepsy or receiving other drugs likely to cause extrapyramidal reactions. Concomitant use with drugs that prolong the QT interval is not recommended. Avoid in patients with a history of tardive dyskinesia.

Possible side effect

Common side effects include restlessness, drowsiness, fatigue, and headache. Gastrointestinal effects such as nausea and diarrhea may occur initially. More serious but less frequent adverse reactions encompass tardive dyskinesia (involuntary, repetitive movements), which may be irreversible; Parkinsonian-like symptoms; and neuroleptic malignant syndrome. Other potential effects include hyperprolactinemia, leading to galactorrhea or gynecomastia, and methemoglobinemia in neonates or those with G6PD deficiency. Allergic reactions, though rare, can manifest as rash, urticaria, or bronchospasm.

Drug interaction

Reglan may interact with central nervous system depressants like opioids, alcohol, or sedatives, potentiating drowsiness and impairment. Concurrent use with drugs that prolong the QT interval (e.g., certain antipsychotics, antibiotics) increases the risk of cardiac arrhythmias. It can affect the absorption of other orally administered drugs by altering gastrointestinal motility. Dopamine agonists and anticholinergic agents may antagonize the effects of metoclopramide. Caution is advised when using with serotonergic drugs due to the potential for serotonin syndrome. Inhibitors of CYP2D6 may increase metoclopramide plasma concentrations.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the usual dosing schedule. Do not double the dose to make up for a missed one, as this increases the risk of adverse effects. Consistent timing relative to meals is important for optimal efficacy, particularly for gastroparesis management. If multiple doses are missed or uncertainty exists, consult a healthcare provider for guidance.

Overdose

Symptoms of overdose may include drowsiness, disorientation, extrapyramidal reactions, and seizures. Cardiovascular effects such as bradycardia or cardiac arrest are possible in severe cases. Management is supportive and symptomatic; there is no specific antidote. Activated charcoal may be administered if ingestion was recent. Extrapyramidal symptoms can often be controlled with diphenhydramine or benztropine. Close monitoring of vital signs and ECG is recommended. Contact a poison control center or seek emergency medical attention immediately if overdose is suspected.

Storage

Store Reglan tablets and oral solution at room temperature, between 20°C to 25°C (68°F to 77°F), in a tightly closed container. Protect from light and moisture. Keep out of reach of children and pets. Do not freeze the oral solution. Discard any unused medication after the expiration date or when treatment is completed, following local guidelines for medication disposal. Do not flush down the toilet or pour into drains unless instructed to do so.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here. The use of Reglan should be strictly under the supervision of a healthcare professional, and individual patient needs may vary.

Reviews

Clinical studies and patient reports indicate that Reglan can be highly effective for symptom relief in gastroparesis and refractory GERD when used appropriately and for short durations. Many users report significant reduction in nausea, vomiting, and bloating within days of initiation. However, concerns about potential side effects, particularly tardive dyskinesia, are frequently noted. Medical professionals emphasize the importance of adhering to prescribed duration and dosage to mitigate risks. Overall, it is considered a valuable option for select patients under careful monitoring, though it is not suitable for long-term management due to safety profiles.