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甲氧氯普胺 (胃復安)

Metoclopramide

Metoclopramide HCl

胃腸促動力藥 / 止吐藥POSCIMIVCRI狗貓小型哺乳類馬

別名: Reglan · Metozolv · Emeprid · Metomotyl · Vomend · Maxolon · AHR-3070-C · DEL-1267 · metoclopramidi hydrochloridum · MK-745 · Metoclopramide hydrochloride

由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本

經審核的 v13 劑量證據

結構化劑量計算證據

Gastrointestinal stasis after obstruction has been excluded

0.5 mg/kgPOSC

須由已驗證獸醫確認

  • q6–8h
必須同時考慮的臨床上下文 (2)
  • Exclude emergent diagnoses (obstruction, enterotoxemia)
  • Prokinetic agent (after excluding the possibility of obstruction)
高風險須由已驗證獸醫確認textbook方案年份 2021審核 dose-audit-v13

劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。

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概覽

甲氧氯普胺在獸醫學中是一種廣泛使用的​胃腸促動力藥​和​止吐藥​。

  • ​促動力作用​：主要作用於上消化道（胃和小腸），對結腸的影響極小。臨床上用於胃排空遲緩、胃食道逆流和術後腸阻塞。
  • ​止吐作用​：由於犬的化學受體觸發區 (CRTZ) 含有豐富的多巴胺受體，因此對犬非常有效。相反，貓的 D2 受體較少，使得甲氧氯普胺在貓身上的止吐效果較不可靠（通常首選 alpha-2 拮抗劑或 NK-1 拮抗劑如 maropitant）。

​臨床要點​：

  • 常以連續靜脈輸注 (CRI) 的方式用於嚴重疾病，如犬小病毒腸炎或急性胰臟炎。
  • 由於它能穿過血腦屏障，可能會引起顯著的錐體外系副作用（例如震顫、焦躁不安、狂亂行為），特別是在高劑量或對此藥敏感的物種（如馬）中。

作用機制

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.

安全性與警告

禁忌症

  • 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)

不良反應

  • 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

注意事項

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.

藥物相互作用

Aspirin, Acetaminophen, Alcohol

Metoclopramide may enhance the absorption of these agents.

Anesthetics

Acute hypotension has been reported if metoclopramide is used concurrently IV.

Atropine (and anticholinergics)

May antagonize the GI motility effects of metoclopramide.

Cephalexin

Oral metoclopramide increases cephalexin peak plasma concentrations and AUC in dogs.

Cholinergic Drugs (e.g., bethanechol)

May enhance metoclopramide's GI effects.

CNS DepressantsModerate

Metoclopramide may enhance CNS depressant effects.

Cyclosporine

Metoclopramide increases the rate and extent of GI absorption.

Opiate Analgesics

May antagonize the GI motility effects and enhance metoclopramide's CNS effects.

MAO Inhibitors (e.g., amitraz, selegiline)

Could cause hypertension.

Phenothiazines and Butyrophenones

May potentiate the extrapyramidal effects of metoclopramide.

Propofol

Reduces induction requirements of propofol by 20-25%.

SSRI Antidepressants

Potential for enhanced extrapyramidal effects.

Tetracyclines

Metoclopramide increases the rate and extent of GI absorption.

Phenothiazines (e.g., Acepromazine)Major

Increased risk of extrapyramidal effects and CNS depression

OpioidsModerate

May antagonize the gastrointestinal prokinetic effects of metoclopramide

Anticholinergics (e.g., Atropine)Moderate

Antagonize the prokinetic effects on the gastrointestinal tract

監測

  • 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)

藥物動力學

半衰期

貓Approximately 90 minutes狗~90 minutes

吸收

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.

分佈

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.

代謝

The majority of the drug is metabolized to glucuronidated or sulfated conjugate forms.

排除

Primarily excreted in the urine (20-25% unchanged, the rest as metabolites). Approximately 5% is excreted in the feces.

過量

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.

可用產品

劑型

  • 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

獸醫用

  • None
  • Emeprid 5 mg/ml injectable solution
  • Emeprid 1 mg/ml oral solution
  • Metomotyl
  • Vomend

人用標示

  • 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

各地核准狀態

European Union✓ 已核准處方藥EMA
🐕 Dogs🐈 Cats

Classified as POM-V (Prescription Only Medicine - Veterinarian).

United Kingdom✓ 已核准處方藥VMD
🐕 Dogs🐈 Cats

Classified as POM-V.

暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

儲存與穩定性

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.

飼主須知

甲氧氯普胺用於幫助胃部排空並預防噁心和嘔吐。

  • ​給藥方式​：為了達到最佳的促動力效果，請在寵物進食前約 30 分鐘給藥。
  • ​行為改變​：觀察是否有異常行為。在狗身上，這可能表現為焦躁不安、來回踱步或具攻擊性。在貓身上，可能表現為狂亂行為或失去方向感。

  • ​緊急警告​：如果您的寵物出現不自主的肌肉痙攣、眼睛/臉部/四肢抽搐或姿勢僵硬，請立即聯繫您的獸醫師。這些被稱為錐體外系症狀，可以透過獸醫師提供的特定藥物迅速逆轉。

  • 請將藥物存放在室溫下並避光保存。

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