Prophylaxis metoclopramide

Metoclopramide is used for its antiemetic properties in patients with diabetic gastroparesis and with dexamethasone for prophylaxis of delayed nausea and vomiting associated with chemotherapy administration. 

Even after an effective regimen for prophylaxis, nausea or vomiting can begin again or persist 24 h or more after chemotherapy, particularly with cisplatin. Concurrent use of oral dexamethasone (8 mg twice daily for 2 d, then 4 mg twice daily for 2 d) and oral metoclopramide (0.5 mg/kg four times daily for 4 d) has been effective for this condition. Ondansetron alone has not been effective for treatment of delayed emesis following high doses of cisplatin. 

De Mulder PH, Seynaeve C, Vermorken JB, et al. Ondansetron compared with high-dose metoclopramide in prophylaxis of acute and delayed cisplatin-induced nausea and vomiting A multicenter, randomized, double-blind, crossover study. Ann Intern Med 1990 113 834-840. 

Oral metoclopramide is indicated in the treatment of diabetic gastroparesis (10 mg 30 minutes before each meal and at bedtime for 2 to 8 weeks) and symptomatic gastroesophageal reflux (10 to 15 mg orally up to 4 times daily 30 minutes before each meal and at bedtime for 4 to 12 weeks). Furthermore, parenteral metoclopramide is indicated in prevention of nausea and vomiting associated with emetogenic cancer chemotherapy, for prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable, and as a single dose to facilitate small-bowel intubation when the tube does not pass the pylorus with conventional maneuvers. 

Manchikanti L, Grow JB, Colliver JA, Hadley CH, Hohlbein LJ. Bicitra (sodium citrate) and metoclopramide in outpatient anesthesia for prophylaxis against aspiration pneumonitits. Anesthesiology 1985 63 378-384. 

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