Metoclopramide
Metoclopramide HCl
Also known as: Reglan · Metozolv · Emeprid · Metomotyl · Vomend · Maxolon · AHR-3070-C · DEL-1267 · metoclopramidi hydrochloridum · MK-745 · Metoclopramide hydrochloride
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Audited v13 dosing evidence
Structured calculator evidenceGastrointestinal stasis after obstruction has been excluded
Verified clinician required
- q6–8h
Governing clinical context (2)
- Exclude emergent diagnoses (obstruction, enterotoxemia)
- Prokinetic agent (after excluding the possibility of obstruction)
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Metoclopramide is a widely used gastrointestinal prokinetic and antiemetic agent in veterinary medicine.
- Prokinetic Effects: It primarily targets the upper GI tract (stomach and small intestine) with minimal effect on the colon. It is used clinically for gastric stasis, gastroesophageal reflux, and post-operative ileus.
- Antiemetic Effects: It is highly effective in dogs due to their abundance of dopaminergic receptors in the chemoreceptor trigger zone (CRTZ). Conversely, cats have fewer D2 receptors, making metoclopramide a less reliable antiemetic in felines (where alpha-2 antagonists or NK-1 antagonists like maropitant are often preferred).
Clinical Pearls:
- Often administered as a continuous rate infusion (CRI) for severe conditions like parvoviral enteritis or acute pancreatitis.
- Because it crosses the blood-brain barrier, it can cause notable extrapyramidal side effects (e.g., tremors, restlessness, frenzied behavior), especially at higher doses or in sensitive species like horses.
Mechanism of action
Metoclopramide exerts its effects through both peripheral gastrointestinal and central nervous system mechanisms:
- Peripheral (GI Tract): Sensitizes upper GI smooth muscle to acetylcholine → increases tone and amplitude of gastric contractions, relaxes the pyloric sphincter, and increases duodenal and jejunal peristalsis. It also increases lower esophageal sphincter (LES) pressure, reducing reflux.
- Central (CNS): Antagonizes Dopamine (D2) receptors in the Chemoreceptor Trigger Zone (CRTZ) → blocks emetic signaling to the vomiting center, providing a potent central antiemetic effect.
- Additional Mechanisms: At higher doses, it exhibits weak 5-HT3 (Serotonin) receptor antagonism and 5-HT4 receptor agonism, further contributing to its antiemetic and prokinetic profiles.
Safety & warnings
Contraindications
- GI hemorrhage
- GI obstruction or perforation
- Hypersensitivity to metoclopramide
- Seizure disorders (relatively contraindicated, lowers seizure threshold)
- Head trauma
- Pheochromocytoma (may induce hypertensive crisis)
- Concurrent phenothiazine therapy
- Dogs with pseudopregnancy (stimulates prolactin release)
- Gastrointestinal obstruction
- Gastrointestinal perforation
- Gastrointestinal hemorrhage
- Seizure disorders (epilepsy)
Adverse effects
- Dogs: Changes in mentation and behavior (motor restlessness, involuntary spasms, aggression, hyperactivity to drowsiness/depression), constipation
- Cats: Frenzied behavior, disorientation, constipation
- Horses: Severe CNS effects (IV use), alternating sedation and excitement, behavioral changes, abdominal pain
- Extrapyramidal effects (tremors, rigid posture)
- Nausea and diarrhea
- Transient hypertension
- Elevated prolactin levels
- Extrapyramidal signs (tremors, twitching, hyperactivity, restlessness)
- Constipation or diarrhea
- Changes in mentation or behavior
Precautions
Absolute Contraindication: Do not use in patients with suspected or confirmed GI obstruction, perforation, or hemorrhage.
- Use with extreme caution in patients with a history of seizures, as metoclopramide can lower the seizure threshold.
- Dosage adjustment (reduce CRI by 25-50%) may be required in patients with renal failure.
- Avoid use in dogs experiencing pseudopregnancy due to its prolactin-stimulating effects.
- Monitor closely for extrapyramidal signs (involuntary muscle spasms, rigidity, tremors), which can be reversed with anticholinergic agents like diphenhydramine.
Drug interactions
Metoclopramide may enhance the absorption of these agents.
Acute hypotension has been reported if metoclopramide is used concurrently IV.
May antagonize the GI motility effects of metoclopramide.
Oral metoclopramide increases cephalexin peak plasma concentrations and AUC in dogs.
May enhance metoclopramide's GI effects.
Metoclopramide may enhance CNS depressant effects.
Metoclopramide increases the rate and extent of GI absorption.
May antagonize the GI motility effects and enhance metoclopramide's CNS effects.
Could cause hypertension.
May potentiate the extrapyramidal effects of metoclopramide.
Reduces induction requirements of propofol by 20-25%.
Potential for enhanced extrapyramidal effects.
Metoclopramide increases the rate and extent of GI absorption.
Increased risk of extrapyramidal effects and CNS depression
May antagonize the gastrointestinal prokinetic effects of metoclopramide
Antagonize the prokinetic effects on the gastrointestinal tract
Monitoring
- Clinical efficacy (resolution of vomiting, improved GI transit)
- Adverse effects (especially CNS and extrapyramidal signs)
- Clinical response (reduction in vomiting, improved gastric emptying)
- Hydration status and electrolyte balance
- Signs of extrapyramidal adverse effects (twitching, restlessness)
Pharmacokinetics
Half-life
Absorption
Well absorbed after oral administration, but a significant first-pass effect may reduce systemic bioavailability to ~30% (high interpatient variation). Bioavailability after IM administration is 74-96%. Peak plasma levels generally occur within 2 hours after oral dosing.
Distribution
Well distributed in the body and enters the CNS. Weakly bound to plasma proteins (13-22%). Crosses the placenta and enters milk in concentrations approximately twice those of plasma.
Metabolism
The majority of the drug is metabolized to glucuronidated or sulfated conjugate forms.
Elimination
Primarily excreted in the urine (20-25% unchanged, the rest as metabolites). Approximately 5% is excreted in the feces.
Overdose
The oral LD50 doses are very high (465-870 mg/kg in laboratory animals), making death from oral overdose unlikely in veterinary patients.
Clinical Signs of Toxicity:
- Sedation, ataxia, agitation
- Extrapyramidal effects (tremors, rigidity, spasms)
- Nausea, vomiting, constipation
Treatment:
- No specific antidote exists.
- If ingestion was recent, empty the stomach using standard protocols.
- Anticholinergic agents that enter the CNS (e.g., diphenhydramine at 2.2 mg/kg IV, or benztropine) are highly effective in controlling extrapyramidal effects.
- Peritoneal dialysis or hemodialysis is not effective for drug removal.
Available products
Formulations
- Oral Tablets: 5 mg, 10 mg
- Oral Disintegrating Tablets: 5 mg, 10 mg
- Oral Syrup: 1 mg/mL
- Injection Solution: 5 mg/mL
- Injectable: 5 mg/ml solution
- Oral: 1 mg/ml solution
Veterinary
- None
- Emeprid 5 mg/ml injectable solution
- Emeprid 1 mg/ml oral solution
- Metomotyl
- Vomend
Human-labeled
- Metoclopramide HCl Oral Tablets: 5 mg & 10 mg (Reglan, Metozolv, generic)
- Metoclopramide HCl Oral Disintegrating Tablets: 5 mg & 10 mg
- Metoclopramide HCl Oral Syrup: 1 mg/mL
- Metoclopramide HCl Injection Solution: 5 mg/mL (Reglan, generic)
- Maxolon
Regulatory status
Classified as POM-V (Prescription Only Medicine - Veterinarian).
Classified as POM-V.
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Photosensitive; must be stored in light-resistant containers at room temperature. Tablets should be kept in tight containers. Injection is stable in solutions with a pH of 2-9 and compatible with D5W, 0.9% NaCl, Ringer's, and LRS.
Client information
Metoclopramide is used to help empty the stomach and prevent nausea and vomiting.
- Administration: For best results as a prokinetic, administer the medication about 30 minutes before your pet's meal.
- Behavioral Changes: Watch for unusual behavior. In dogs, this may look like restlessness, pacing, or aggression. In cats, it may manifest as frenzied behavior or disorientation.
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Emergency Warning: Contact your veterinarian immediately if your pet develops involuntary muscle spasms, twitching of the eyes/face/limbs, or a rigid posture. These are known as extrapyramidal signs and can be quickly reversed with specific medications provided by your vet.
- Store the medication at room temperature and protect it from light.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.