Metoclopramide

Metoclopramide (MCP) is a drug that acts on the gastrointestinal tract. Metoclopramide reduces nausea and vomiting and increases stomach activity. It is available in different forms, such as tablets, drops or suppositories.

What is metoclopramide?

Metoclopramide is a prescription drug mainly used for nausea and vomiting.Because of its rare but serious side effects on the musculoskeletal system, it should not be used for more than 5 days.

Metoclopramide must not be used in children under 2 years of age and patients with certain pre-existing conditions (especially intestinal obstruction, gastric and intestinal bleeding, epilepsy).

Pharmacological effect

Metoclopramide belongs to the dopamine antagonists. As an endogenous messenger substance, dopamine can trigger vomiting by binding to its binding sites in the vomiting center in the brain stem.

Metoclopramide prevents the binding of dopamine to its binding site (receptor). This neutralizes effects mediated by dopamine. Receptors for dopamine are mainly located in the brain. Here dopamine also mediates other processes, such as the control of voluntary movements. This mechanism of action can explain some of the side effects of metoclopramide.

Other binding sites for dopamine are found in the gastrointestinal tract, where it helps slow down digestion. Metoclopramide also influences the receptors of serotonin, another endogenous messenger substance. Binding sites for serotonin are also located in the brain, but also in the gastrointestinal tract. Here metoclopramide increases stomach activity and shortens the passage time of food.

In addition, metoclopramide increases the concentration of a certain sex hormone, prolactin. Among other things, this sex hormone regulates the production of milk in the mammary gland. Metoclopramide is filtered out of the blood again by the kidneys and then excreted in the urine. In the case of reduced kidney function (renal insufficiency), attention must therefore be paid to the dosage.

Medical application & use

Metroclopramide is a prescription drug. It works reliably against nausea and vomiting. Accordingly, metoclopramide is used for various causes of nausea:

for travel sickness, migraines, drug intolerance, traumatic brain injury and after operations. However, the effect on nausea caused by chemotherapy and after operations is limited, which is why other drugs are also used here.

Metoclopramide is also used to improve gastric emptying. Metoclopramide can be used as a support in the treatment of an irritable stomach or heartburn. This effect of metoclopramide is also used to accelerate the onset of action of other drugs. For this reason, metoclopramide is often a component of migraine medication.

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Risks & side effects

There Metoclopramide acts on a diverse receptor, its side effects are also complex. Occasionally, metoclopramide causes tiredness and dizziness. Patients also sometimes express headaches and sleep disorders.

Side effects that affect the coordination of movements are less common, but far more serious. Patients then experience tremors, muscle spasms, and involuntary movements. Tardive dyskinesias, movement disorders that occur after long-term use of certain drugs, are particularly feared. Affected people constantly chew, make faces involuntarily and suddenly move their arms and legs violently without wanting to. Tardive dyskinesias are usually irreversible, which means that they do not subside after stopping the triggering drug.

For this reason, the EMA, the European Medicines Agency, recommends viewing the use of metoclopramide even more critically. In addition, because of the risk of tardive dyskinesia, applications longer than 5 days should be avoided. Due to the increased prolactin level, milk secretion can also occur in non-pregnant women. Women also often complain of menstrual cramps. In men, the mammary gland can become enlarged. If side effects occur, a doctor should be asked for advice immediately. If the side effects are severe, the drug should be discontinued immediately.

Metoclopramide can be used in children from 2 years of age. Applications should be viewed critically during pregnancy and not allowed at all during breastfeeding. Metoclopramide must not be used in patients with certain pre-existing conditions. These include obstruction of the intestine due to obstruction of the intestine, bleeding in the gastrointestinal tract (due to stomach ulcers, tumors, etc.), epilepsy and depression (when taking drugs from a certain group, so-called MAO inhibitors).