Consumer medicine information

Metoclopramide-WGR

Metoclopramide hydrochloride

BRAND INFORMATION

Brand name

Metoclopramide-WGR

Active ingredient

Metoclopramide hydrochloride

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Metoclopramide-WGR.

SUMMARY CMI

METOCLOPRAMIDE-WGR

Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.

1. Why am I using METOCLOPRAMIDE-WGR?

METOCLOPRAMIDE-WGR contains the active ingredient metoclopramide hydrochloride. METOCLOPRAMIDE-WGR is used to treat nausea, and vomiting caused by infectious diseases, migraine kidney disease, childbirth, other medications, cancer, or following surgery, chemotherapy or radiation treatment, to activate stomach contractions in conditions where there is a need to encourage normal passage of food through the stomach and intestines.

For more information, see Section 1. Why am I using METOCLOPRAMIDE-WGR? in the full CMI.

2. What should I know before I use METOCLOPRAMIDE-WGR?

Do not use if you have ever had an allergic reaction to METOCLOPRAMIDE-WGR or any of the ingredients listed at the end of the CMI.

Talk to your doctor if you have any other medical conditions, take any other medicines, or are pregnant or plan to become pregnant or are breastfeeding.

For more information, see Section 2. What should I know before I use METOCLOPRAMIDE-WGR? in the full CMI.

3. What if I am taking other medicines?

Some medicines may interfere with METOCLOPRAMIDE-WGR and affect how it works.

A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

4. How do I use METOCLOPRAMIDE-WGR?

  • The total daily dosage of metoclopramide hydrochloride (as monohydrate), especially for children and young adults, should not normally exceed 0.5mg/kg bodyweight or 30mg daily.
  • Swallow the tablets with a glass full of water.

More instructions can be found in Section 4. How do I use METOCLOPRAMIDE-WGR? in the full CMI.

5. What should I know while using METOCLOPRAMIDE-WGR?

Things you should do
  • Remind any doctor, dentist, or pharmacist you visit that you are using METOCLOPRAMIDE-WGR.
  • If you are about to be started on any new medicines, remind your doctor and pharmacist that you are taking Metoclopramide-WGR.
Things you should not do
  • Do not stop using this medicine suddenly.
  • Do not give your medicine to anyone else, even if they have the same condition.
Driving or using machines
  • Be careful driving or operating machinery until you know how Metoclopramide-WGR affects you.
  • This medicine may cause dizziness, light-headedness, tiredness or drowsiness in some people.
Drinking alcohol
  • Be careful when drinking alcohol while you are taking this medicine. If you drink alcohol, it may make you sleepy.
Looking after your medicine
  • Keep your medicine in the pack until it is time to take it. If you take the tablets out of the pack, they may not keep well.
  • Keep your tablets in a cool dry place where the temperature stays below 25°C.

For more information, see Section 5. What should I know while using METOCLOPRAMIDE-WGR? in the full CMI.

6. Are there any side effects?

The common side effects include drowsiness, tiredness, restlessness, dizziness, headache, bowel irregularities, insomnia, anxiety, agitation.

For more information, including what to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.



FULL CMI

METOCLOPRAMIDE-WGR

Active ingredient(s): metoclopramide hydrochloride


Consumer Medicine Information (CMI)

This leaflet provides important information about using METOCLOPRAMIDE-WGR. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about using METOCLOPRAMIDE-WGR.

Where to find information in this leaflet:

1. Why am I using METOCLOPRAMIDE-WGR?
2. What should I know before I use METOCLOPRAMIDE-WGR?
3. What if I am taking other medicines?
4. How do I use METOCLOPRAMIDE-WGR?
5. What should I know while using METOCLOPRAMIDE-WGR?
6. Are there any side effects?
7. Product details

1. Why am I using METOCLOPRAMIDE-WGR?

METOCLOPRAMIDE-WGR contains the active ingredient metoclopramide hydrochloride. METOCLOPRAMIDE-WGR is acts by blocking the action of a chemical in the brain which causes nausea and vomiting. It also acts in the stomach and upper intestine to increase muscle contractions.

METOCLOPRAMIDE-WGR is used in adults over 20 years to treat nausea, and vomiting caused by infectious diseases, migraine kidney disease, childbirth, other medications, cancer, or following surgery, chemotherapy or radiation treatment, to activate stomach contractions in conditions where there is a need to encourage normal passage of food through the stomach and intestines, with X-rays to help diagnose problems of the stomach and/or intestines, to help with passing tubes into the intestine.

In young adults between 15 15 to 20 years METOCLOPRAMIDE-WGR is used to treat severe vomiting of known cause or following chemotherapy or radiation treatment and help with passing tubes.

2. What should I know before I use METOCLOPRAMIDE-WGR?

Warnings

Do not use METOCLOPRAMIDE-WGR if:

  • you are allergic to metoclopramide hydrochloride, or any of the ingredients listed at the end of this leaflet.
  • Some of the symptoms of allergic reaction include shortness of breath, wheezing or difficulty breathing, swelling of the face, lips, togue or other parts of the body, rash, itching or hives on the skin.
  • Always check the ingredients to make sure you can use this medicine.
  • Active bleeding from the stomach and/or digestive tract.
  • Blockage of the stomach and/or digestive tract
  • Recent surgery of the stomach and/or digestive tract
  • pheochromocytoma (an adrenaline-producing tumour of the adrenal gland)
  • epilepsy (fits or seizures)
  • take other medication such as antipsychotic/neuroleptic medication and certain antidepressants that can cause movement disorders (extrapyramidal reactions).

Check with your doctor if you:

  • have any other medical condition like Parkinson's disease, liver or kidney problem, high blood pressure, asthma.
  • take any medicines for any other condition.

During treatment, you may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor if you are pregnant or intend to become pregnant.

Talk to your doctor if you are breastfeeding or intend to breastfeed.

3. What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines may interfere with METOCLOPRAMIDE-WGR and affect how it works.

  • Tranquilizers or anti-anxiety medications
  • Strong pain killers (e.g., codeine or morphine)
  • Sedatives or sleeping medication.
  • Atropine-like medication (e.g., some cold preparations, travel sickness medicines)
  • Tetracycline antibiotics, paracetamol, levodopa
  • digoxin

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins or supplements you are taking and if these affect METOCLOPRAMIDE-WGR.

4. How do I use METOCLOPRAMIDE-WGR?

How much to take / use

  • The dose of Metoclopramide-WGR varies with the age of the patient and with the reason for use.
  • The total daily dosage of metoclopramide hydrochloride (as monohydrate), especially for children and young adults, should not normally exceed 0.5mg/kg bodyweight or 30mg daily.
  • Space the doses as evenly as possible throughout the day.
  • Tablets:
    20 years and over
    – One tablet (10mg) every 8 hours
    15-20 years – ½ to 1 tablet (5mg to 10mg) every 8 hours

Swallow the tablets with a glass full of water.

The tablets can be broken in half (along the break line) Do not exceed the prescribed dose.

When to take / use METOCLOPRAMIDE-WGR

  • METOCLOPRAMIDE-WGR should be used at about the same time each day. Taking it at the same time each day will have the best effect. It will also help you remember when to take it.
  • Take the medicine 30 minutes before meals.
  • Continue taking the medicine for as long as your doctor tells you.

If you forget to use METOCLOPRAMIDE-WGR

METOCLOPRAMIDE-WGR should be used regularly at the same time each day. Taking it at the same time each day will have the best effect. It will also help you remember when to take it.

If you miss your dose at the usual time, take it as soon as you remember it, and then go back to taking this medicine as you would normally.

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.

Do not take a double dose to make up for the dose you missed. This may increase the chance of getting unwanted side effects.

If you are not sure what to do, ask your doctor of pharmacist.

If you have trouble remembering your medicine

If you use too much METOCLOPRAMIDE-WGR

If you think that you have used too much METOCLOPRAMIDE-WGR, you may need urgent medical attention.

You should immediately:

  • phone the Poisons Information Centre
    (by calling 13 11 26), or
  • contact your doctor, or
  • go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

5. What should I know while using METOCLOPRAMIDE-WGR?

Things you should do

Call your doctor straight away if you:

  • If vomiting or nausea persists, tell your doctor
  • If you are about to be started on any new medicines, remind your doctor and pharmacist that you are taking Metoclopramide-WGR.
  • Tell any other doctor, dentists, and pharmacists who treat you hat you are taking this medicine.
  • If you are going to have surgery, tell the surgeons or anesthetists that you are taking this medicine. It may affect other medicines used during surgery.
  • If you become pregnant while taking this medicine, tell your doctor immediately.

Remind any doctor, dentist or pharmacist you visit that you are using METOCLOPRAMIDE-WGR.

Things you should not do

  • Do not stop use METOCLOPRAMIDE-WGR to treat any other complaints unless your doctor tells you to.
  • Do not give your medicine to anyone else, eveN if they have the same condition.

Driving or using machines

Be careful before you drive or use any machines or tools until you know how METOCLOPRAMIDE-WGR affects you.

Be careful driving or operating machinery until you know how Metoclopramide-WGR affects you. This medicine may cause dizziness, light-headedness, tiredness or drowsiness in some people. If you have any of these symptoms, do not drive, operate machinery or do anything else that could be dangerous. Children should be careful when riding bicycles or climbing trees.

Drinking alcohol

Tell your doctor if you drink alcohol.

Be careful when drinking alcohol while you are taking this medicine. If you drink alcohol, it may make you sleepy.

Looking after your medicine

  • Keep your medicine in the pack until it is time to take it. If you take the tablets out of the pack, they may not keep well.
  • Keep your tablets in a cool dry place where the temperature stays below 25°C.

Follow the instructions in the carton on how to take care of your medicine properly.

Store it in a cool dry place away from moisture, heat or sunlight; for example, do not store it:

  • in the bathroom or near a sink, or
  • in the car or on window sills.

Keep it where young children cannot reach it.

Getting rid of any unwanted medicine

If you no longer need to use this medicine or it is out of date, take it to any pharmacy for safe disposal.

Do not use this medicine after the expiry date.

6. Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions about side effects.

Less serious side effects

Less serious side effectsWhat to do
  • Drowsiness, tiredness
  • Restlessness
  • Dizziness, headache
  • Bowel irregularities
  • Insomnia
  • Anxiety
  • Agitation
Speak to your doctor if you have any of these less serious side effects and they worry you.

Serious side effects

Serious side effectsWhat to do
  • uncontrolled or repeated movements - e.g. sucking or smacking of the lips, darting of the tongue, chewing movements, uncontrolled movements of the arms or legs. This may be a sign of tardive dyskinesia, a movement disorder which potentially can be irreversible.
  • Fast heartbeat
  • Depression
  • Swelling of hands, ankles, or feet
  • allergic reaction including fainting, swelling of limbs, face, lips, mouth, or throat which may cause difficulty swallowing or breathing.
  • sudden uncontrolled muscle spasm, stiffness of the arms or legs, muscle spasm of the face, locked-jaw or upturned eyes.
  • shuffling walk, slowing of all movement, muscle tremor
  • neuroleptic malignant syndrome, a serious reaction with a sudden increase in body temperature, extremely high blood pressure and severe convulsions.
Call your doctor straight away, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects.

Tell your doctor or pharmacist if you notice anything else that may be making you feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects

After you have received medical advice for any side effects you experience, you can report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems. By reporting side effects, you can help provide more information on the safety of this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop taking any of your medicines.

7. Product details

This medicine is only available with a doctor's prescription.

What METOCLOPRAMIDE-WGR contains

Active ingredient
(main ingredient)
Metoclopramide Hydrochloride (as monohydrate)
Other ingredients
(inactive ingredients)
  • Maize starch
  • Pregelatinised maize starch
  • Microcrystalline cellulose
  • Colloidal anhydrous silica
  • Stearic acid
  • Hypromellose
  • Macrogol 6000
  • Titanium dioxide
  • Purified talc
Potential allergensN/A

Metoclopramide-WGR tablets do not contain sucrose, gluten, tartrazine or any other azo dyes.

Do not take this medicine if you are allergic to any of these ingredients.

What METOCLOPRAMIDE-WGR looks like

METOCLOPRAMIDE-WGR tablets are white to off-white, circular, biconvex, film-coated tablets with a break line on both sides.

Metoclopramide-WGR tablets are available in a blister pack of 25 tablets or a bottle of 100 tablets.

Metoclopramide-WGR 10 mg blister pack – AUST R 229649

Metoclopramide-WGR 10 mg bottle – AUST R 268295

Who distributes METOCLOPRAMIDE-WGR

Wagner Pharmaceuticals Pty Ltd
6 Albert Street Preston VIC 3072
Australia
Tel: 1800 936 140

This leaflet was prepared in October 2024.

Published by MIMS January 2025

BRAND INFORMATION

Brand name

Metoclopramide-WGR

Active ingredient

Metoclopramide hydrochloride

Schedule

S4

 

1 Name of Medicine

Metoclopramide hydrochloride anhydrous.

2 Qualitative and Quantitative Composition

Chemical name: N-(diethyl-aminoethyl)-2-methoxy-4-amino-5-chlorbenzamide monohydrochloride monohydrate.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

5 mg tablets.

Metoclopramide-WGR film coated tablets containing metoclopramide hydrochloride 5 mg are white to off-white, circular, biconvex film-coated tablets plain on both sides.

10 mg tablets.

Metoclopramide-WGR film coated tablets containing metoclopramide hydrochloride 10 mg are white to off-white, circular, biconvex film-coated tablets with break line on both sides.

4 Clinical Particulars

4.1 Therapeutic Indications

Adults (20 years and over).

As an adjunct to X-ray examination of the stomach and duodenum.
To assist in intestinal intubation.
To control nausea and vomiting associated with the following conditions: intolerance to essential drugs possessing emetic properties; uraemia; radiation sickness; malignant disease; postoperative vomiting; labour; infectious diseases. There is no clear benefit in motion sickness or other labyrinth disturbances.
Metoclopramide has been found useful in the management of gastric retention after gastric surgery.
Metoclopramide may be useful in the treatment of diabetic gastroparesis of mild to moderate severity. Once control of diabetes has been established by diet and/or insulin, metoclopramide should be discontinued.

Young adults aged 15-19 years.

The use of Metoclopramide in young adults 15-19 years should be restricted to the following situations and only used as second line therapy:
Severe intractable vomiting of known cause;
Vomiting associated with radiotherapy and intolerance to cytotoxic drugs;
As an aid to gastrointestinal intubation.

4.2 Dose and Method of Administration

Metoclopramide injection is unavailable in this brand, however this formulation is available in other brands. Information obtained from this formulation is included in the PI for prescriber information. Where correct dosing required this formulation, refer to the specific product information for these formulations for complete dosage and administration instructions.
Tablets should not be used in children less than 15 years.

Patients with normal renal and hepatic function.

The dosage recommendations given below should be strictly adhered to if side effects of the dystonic type are to be avoided. Total daily dosage of Metoclopramide-WGR Tablets, especially children and for young adults, should not normally exceed 0.5 mg/kg bodyweight with a maximum of 30 mg daily.
Metoclopramide should only be used after careful examination to avoid masking an underlying disorder, e.g. cerebral irritation. Maximum recommended treatment duration is 5 days in all age groups.

Medical indications.

Oral.

Adults: 20 years and over.

10 mg three times daily.

Elderly patients.

As for adults. To avoid adverse reactions, adhere strictly to dosage recommendations and where prolonged therapy is considered necessary, patients should be regularly reviewed.

Young adults: 15-20 years.

5 to 10 mg three times daily, commencing at the lower dosage and used as second line therapy only.

Diagnostic indications.

A single dose of Metoclopramide-WGR Tablets may be given 5 to 10 minutes before the examination. Subject to bodyweight considerations, the following dosages are recommended:

Adults: 20 years and over.

10 to 20 mg.

Young adults: 15-19 years.

10 mg.
Patients with impaired renal and hepatic function: In patients with clinically significant degrees of renal or hepatic impairment, clearance of Metoclopramide-WGR Tablets is likely to be reduced. It is suggested that therapy be initiated at half the recommended dose. Subsequent dosage will depend on individual clinical response.

4.3 Contraindications

Metoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g. in the presence of gastrointestinal haemorrhage, mechanical obstruction, or perforation.
Phaeochromocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumour. Such hypertensive crises may be controlled by phentolamine.
Known hypersensitivity or intolerance to the drug.
Porphyria.
Epilepsy as Metoclopramide-WGR may increase the frequency and severity of seizures.
Metoclopramide should not be administered to patients receiving other drugs which are likely to cause extrapyramidal reactions, since the frequency and severity of extrapyramidal reactions may be increased.
Metoclopramide tablets should not be used in children below 15 years of age.

4.4 Special Warnings and Precautions for Use

Persistent tardive dyskinesia.

Tardive dyskinesia may appear in some patients on long-term therapy or may appear after drug therapy has been discontinued. The risk appears to be greater in elderly patients on high dose therapy, especially females. The symptoms are persistent and can oftentimes appear to be irreversible. The syndrome is characterised by rhythmical involuntary movement of the tongue, face, mouth, or jaw (e.g. protrusion of tongue, puffing of cheeks, puckering of mouth, chewing movements). Sometimes these may be accompanied by involuntary movement of extremities. There is no known effective treatment for tardive dyskinesia, however, in some patient's symptoms may lessen or resolve after metoclopramide hydrochloride treatment is stopped. Antiparkinson agents usually do not alleviate the symptoms of this syndrome.
Although the risk of tardive dyskinesia with metoclopramide has not been extensively studied, one published study reported a tardive dyskinesia prevalence of 20% among patients treated for at least 3 months. Both the risk of developing the syndrome and the likelihood that it will become irreversible are believed to increase with the duration of treatment and the total cumulative dose.
Metoclopramide hydrochloride therapy should routinely be discontinued in patients who develop signs or symptoms of tardive dyskinesia. It has been suggested that fine vermicular movements of the tongue may be an early sign of the syndrome, and, if the medication is stopped at that time, the syndrome may not develop. Tardive dyskinesia may remit, partially or completely, within several weeks to months after metoclopramide is withdrawn. Metoclopramide itself, however, may suppress (or partially suppress) the signs of tardive dyskinesia, thereby masking the underlying disease process. The effect of this symptomatic suppression upon the long-term course of the syndrome is unknown. Therefore, metoclopramide should not be used for the symptomatic control of tardive dyskinesia.
Prolonged treatment (greater than 12 weeks) with metoclopramide should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risks to the patient of developing tardive dyskinesia.
Care should be exercised in patients being treated with other centrally active drugs.
Since extrapyramidal symptoms may occur with both metoclopramide hydrochloride and neuroleptics such as phenothiazines, care should be exercised in the event of both drugs being prescribed concurrently. (See Section 4.5 Interactions with Other Medicines and Other Forms of Interactions). The frequency and severity of seizures or extrapyramidal reactions may be increased in epileptic patients given Metoclopramide.
Dystonic reactions occur in approximately 1% of patients given metoclopramide hydrochloride. These occur more frequently in children and young adults and may occur after a single dose.
Neuroleptic Malignant Syndrome has been reported with metoclopramide hydrochloride in combination with neuroleptics as well as with metoclopramide hydrochloride monotherapy (see Section 4.8 Adverse Effects (Undesirable Effects)).

Prolactin levels.

Metoclopramide hydrochloride elevates prolactin levels, and the elevation persists during chronic administration (see Section 4.8 Adverse Effects (Undesirable Effects)). Tissue culture experiments indicate that approximately one-third of human breast cancers are prolactin dependent in vitro, a factor of potential importance if the prescription of metoclopramide hydrochloride is contemplated in a patient with previously detected breast cancer. Although disturbances such as galactorrhoea, amenorrhoea, gynaecomastia, and impotence have been reported with prolactin elevating drugs, the clinical significance of elevated serum prolactin levels is unknown for most patients. An increase in mammary neoplasms has been found in rodents after chronic administration of prolactin stimulating neuroleptic drugs. Neither clinical studies nor epidemiological studies conducted to date, however, have shown an association between chronic administration of these drugs and mammary tumorigenesis; the available evidence is too limited to be conclusive at this time.

Other.

Following operations such as pyloroplasty or gut anastomosis, metoclopramide hydrochloride therapy should be withheld for three or four days as vigorous muscular contractions may not help healing.
Special care should be taken in cases of severe renal insufficiency (see Section 4.2 Dose and Method of Administration).
The symptomatic relief provided by metoclopramide hydrochloride may delay recognition of serious disease. It should not be prescribed until diagnosis has been established and should not be substituted for appropriate investigation of the patient's symptoms.
If vomiting persists in a patient receiving metoclopramide hydrochloride, the patient should be reassessed to exclude the possibility of an underlying disorder e.g. cerebral irritation.
Patients should be cautioned about engaging in activities requiring mental alertness for a few hours after the drug has been administered.
Metoclopramide induced depression has been reported in patients without a prior history of depression. Metoclopramide should be given to patients with a prior history of depression only if the expected benefits outweigh the potential risks.
Metoclopramide should be used with caution in patients with hypertension as intravenously administered metoclopramide has been shown to release catecholamines.
Metoclopramide can exacerbate parkinsonian symptoms, therefore it should be used with caution, if at all, in patients with parkinsonian syndrome (see Section 4.8 Adverse Effects (Undesirable Effects)).

Identified precautions.

No data available.

Use in hepatic impairment.

In patients with clinically significant degrees of hepatic impairment, clearance of Metoclopramide is likely to be reduced (see Section 4.2 Dose and Method of Administration).

Use in renal impairment.

In patients with clinically significant degrees of renal impairment, clearance of Metoclopramide is likely to be reduced.
Special care should be taken in cases of severe renal insufficiency (see Section 4.2 Dose and Method of Administration).

Use in the elderly.

To avoid adverse reactions adhere strictly to dosage recommendations and where prolonged therapy is considered necessary, patients should be regularly reviewed (see Section 4.2 Dose and Method of Administration).

Paediatric use.

Metoclopramide tablets is contraindicated in children less than 15 years of age. Metoclopramide should not be given to children unless a clear indication has been established for its use, because of the higher incidence of adverse reactions in this age group.

Effects on laboratory tests.

No data available.

4.5 Interactions with Other Medicines and Other Forms of Interactions

The effects of metoclopramide hydrochloride on gastrointestinal motility are antagonised by anticholinergic drugs and narcotic analgesics. Additive sedative effects can occur when metoclopramide hydrochloride is given with alcohol, sedatives, hypnotics, narcotics, or tranquillisers.
Since metoclopramide hydrochloride accelerates abnormally slow gastric and small bowel peristaltic activity, it may change absorption of orally administered drugs. The absorption of drugs from the small bowel may be accelerated (e.g. paracetamol, tetracycline, levodopa), whereas absorption of drugs from the stomach may be diminished (e.g. digoxin).
Metoclopramide may cause extrapyramidal symptoms in some patients. Therefore, when metoclopramide is used concomitantly with other drugs that are likely to cause extrapyramidal reactions (e.g. neuroleptics such as phenothiazines), caution should be exercised.
The decrease in gastric emptying time caused by metoclopramide may increase the bioavailability of cyclosporin. Monitoring of cyclosporin concentrations may be necessary.
When metoclopramide is given concurrently with suxamethonium the recovery time is prolonged.
Since metoclopramide influences the delivery of food to the intestine and thus the rate of its absorption, the administration of metoclopramide may result in poor diabetic control in some patients. Therefore, adjustment in, or timing of, insulin dosage may be necessary in insulin-controlled diabetics.
The finding that metoclopramide releases catecholamines in patients with essential hypertension suggests that it should be used cautiously, if at all, in patients receiving monoamine oxidase inhibitors.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No data available.
(Category A)
Adequate human data on use during pregnancy are not available.
Adequate human data on use during lactation and adequate animal reproduction studies are not available.

4.7 Effects on Ability to Drive and Use Machines

Patients should be cautioned about engaging in activities requiring mental alertness for a few hours after the drug has been administrated.

4.8 Adverse Effects (Undesirable Effects)

The most frequent adverse reactions to metoclopramide hydrochloride are restlessness, drowsiness, fatigue, and lassitude, which occur in approximately 10% of patients.
Less frequently, insomnia, headache, dizziness, nausea, or bowel disturbances may occur. Rare (less than 1 in 1,000) cases of acute depression have been reported. Anxiety or agitation may occur especially after rapid injection.
A single instance of supraventricular tachycardia following intramuscular administration has been reported. There have been very rare (less than 1 in 10,000) cases of abnormalities of cardiac conduction (such as bradycardia and heart block) in association with intravenous metoclopramide. Atrial fibrillation (AF), oedema, tachycardia and palpitations have been associated with the use of metoclopramide.
Although uncommon at normal dosage, various extrapyramidal reactions to metoclopramide hydrochloride, usually of the dystonic type, have been reported. Reactions include spasm of the facial muscles, trismus, rhythmic protrusion of the tongue, a bulbar type of speech, spasm of the extraocular muscles including oculogyric crises, unnatural positioning of the head and shoulders and opisthotonos. There may be a generalised increase in muscle tone. The majority of reactions occur within 36 hours of starting treatment and the effects usually disappear within 24 hours of withdrawal of the drug, however, close observation is required and in cases of more severe reactions, an antiparkinson drug such as benztropine or an anticholinergic antihistamine such as diphenhydramine should be given. A fatal dystonic reaction has been reported in a patient who received hexamethylmelamine, cisplatin and high dose metoclopramide. A fatal cardiorespiratory arrest has occurred in at least one patient with an acute dystonic reaction.
Tardive dyskinesia, which may be persistent, has been reported particularly in elderly patients undergoing long-term therapy with metoclopramide hydrochloride.
Very rare (less than 1 in 10,000) occurrences of the Neuroleptic Malignant Syndrome have been reported. This syndrome is potentially fatal and comprises hyperpyrexia, altered consciousness, muscle rigidity, autonomic instability and elevated levels of CPK and must be treated urgently (recognised treatments include dantrolene and bromocriptine). Metoclopramide hydrochloride should be stopped immediately if this syndrome occurs.
Parkinsonian symptoms, including tremor, rigidity, bradykinesia and akinesia, occur rarely in patients receiving metoclopramide but may be associated with usual or excessive doses or with decreased renal function.
There have been isolated reports of hypersensitivity reactions (such as urticaria, maculopapular rash) in patients receiving metoclopramide.
Methaemoglobinaemia has also been reported. There have been a few cases of neutropenia, leucopenia and agranulocytosis generally without clear cut relationship to metoclopramide.
Sulfhaemoglobinaemia in adults.
Hyperthermia has also been observed.
Raised serum prolactin levels have been observed during metoclopramide therapy; this effect is similar to that noted with many other compounds. Galactorrhoea and breast enlargement have also been observed during metoclopramide therapy.
Respiratory failure, secondary to dystonic reaction, acute asthmatic symptoms of wheezing and dyspnoea may occur.
Urinary incontinence and frequency, sexual dysfunction, priapism and muscle spasm may also occur.
Rarely, cases of hepatotoxicity, characterised by such findings as jaundice and altered liver function tests, when metoclopramide was administered with other drugs with known hepatotoxic potential.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

Symptoms.

Overdose of metoclopramide may be expected to produce effects that are extensions of common adverse reactions: drowsiness, disorientation and extrapyramidal side effects. Very rarely AV block has been observed. Other reported effects associated with metoclopramide overdose have included feelings of anxiety or restlessness, headache, vertigo, nausea, vomiting, constipation, weakness, hypotension and xerostomia.

Management.

Management of overdosage consists of close observation and supportive therapy. Antiparkinson and antihistamine/anticholinergic drugs such as diphenhydramine hydrochloride have effectively controlled extrapyramidal reactions. Hemodialysis appears ineffective in removing metoclopramide. Similarly, continuous ambulatory peritoneal dialysis does not remove significant amounts of the drug.

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Metoclopramide hydrochloride stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions.
Its mode of action is unclear. It seems to sensitise tissues to the action of acetylcholine. The effect of metoclopramide hydrochloride on motility is not dependent on intact vagal innervation, but it can be abolished by anticholinergic drugs.
Metoclopramide hydrochloride increases the tone and amplitude of gastric (especially antral) contractions, relaxes the pyloric sphincter and the duodenal bulb, and increases peristalsis of the duodenum and jejunum resulting in accelerated gastric emptying and intestinal transit. It increases the resting tone of the lower oesophageal sphincter. It has little, if any effect on the motility of the colon or gall bladder.
Metoclopramide hydrochloride has dopamine antagonist activity. Like the phenothiazines and related drugs, which are also dopamine antagonists, metoclopramide hydrochloride produces sedation and may produce extra-pyramidal reactions (see Section 4.4 Special Warnings and Precautions for Use).
Metoclopramide hydrochloride inhibits the central and peripheral effects of apomorphine, induces release of prolactin and causes a transient increase in circulating aldosterone levels.

Clinical trials.

No data available.

5.2 Pharmacokinetic Properties

Absorption.

The onset of pharmacological action is 1 to 3 minutes following an intravenous dose, 10 to 15 minutes following intramuscular administration, and 30 to 60 minutes following an oral dose; pharmacological effects persist for 1 to 2 hours.
There is marked variability in peak plasma concentrations of metoclopramide hydrochloride after oral administration, which appears to be due to interindividual differences in first-pass metabolism.

Distribution.

Plasma protein binding is 13% to 22%.

Metabolism.

80% of the drug is excreted in the urine in the first 24 hours, approximately half as the glucuronide and sulfate conjugates and half as unchanged drug.

Excretion.

Elimination half-life varies in different studies from 2.5 to 5 hours. Impaired renal function results in reduced clearance of metoclopramide hydrochloride and an increased half-life (15 hours).

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

Metoclopramide-WGR tablets also contain the excipients microcrystalline cellulose, colloidal anhydrous silica, maize starch, stearic acid and pregelatinised maize starch. The coating for the tablets consists of hypromellose, macrogol 6000, titanium dioxide and purified talc.
See Section 2 Qualitative and Quantitative Composition.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Tablets should be stored below 25°C. Protect from light.

6.5 Nature and Contents of Container

Metoclopramide-WGR 10 mg and 5 mg tablets are packed in clear PVDC coated PVC/aluminium blister packs and are available in pack sizes of 10, 20, 25, 30, 50, 60 100, 125 or 150 tablets.
Metoclopramide-WGR 10 mg tablets are also available in 100's HDPE bottle pack with polypropylene child resistant closure and 500's tablets HDPE bottle pack with polypropylene screw cap.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

Chemical structure.


C14H22ClN3O2, HCl, H2O.
Chemical Name: N-(diethyl-aminoethyl)-2-methoxy-4-amino-5-chlorbenzamide monohydrochloride monohydrate.
Molecular weight: 354.3.

CAS number.

54143-57-6.

7 Medicine Schedule (Poisons Standard)

S4 - Prescription only Medicines.

Summary Table of Changes