Metoclopramide cirrhosis patients

The dose of metoclopramide should be reduced by 50% in patients with cirrhosis, as reduced clearance may result in accumulation of the drug. The use of metoclopramide in patients with moderate to severe liver disease may also increase the risk of developing gynae-comastia. 

Feurle GE (1990) Arteriovenous shunting and cholestasis in hepatic hemangiomatosis associated with metoclopramide. Gastroenterology 99 258-262. Magueur E, Horgege H, Attali P, et al. (1991) Pharmacokinetics of metoclopramide in patients with liver cirrhosis. Br J Clin Pharmacol 31 185-187. Albani F, Tame MR, De Palma R, et al. (1991) Kinetics of intravenous metoclopramide in patients with hepatic cirrhosis. Eur ] Clin Pharmacol 40 423-425. 

Magueur E, Hagege H, Attali P, Singlas E, Etienne JP, Taburet AM. Pharmacokinetics of metoclopramide in patients with liver cirrhosis. Br J Clin Pharmacol 1991 31(2) 185-7. 

If there is impaired liver function, metoclopramide can accumulate. In eight patients with severe alcoholic cirrhosis there was a 50% lower clearance than in eight healthy volunteers the apparent volume of distribution and absolute systemic availability were similar in the two groups (15). 

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