Metoclopramide vomiting

B. Two medicines, ipecac and apomorphine, induce vomiting. Metoclopramide is a prokinetic with antiemetic properties and therefore would have the opposite of the desired effect. Morphine is an opioid with analgesic and sedating properties. Promethazine and ondansetron are also antiemetics, not emetics. 

Wallenborn J, Gelbrich G, Bulst D et al (2006) Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone randomised double blind multicentre trial. Br Med J 333 324-327... 

Baits containing this antiemetic at an effective concentration of 1 mg/kg BW shortened the median time for death for dogs from 151 min postdose for 1080 baits without metoclopramide to 132 min (Rathore 1985). At tested doses (1 to 16 mg/kg B W), metoclopramide did not decrease the frequency of vomiting by dogs, but did decrease the amount of vomitus (O Brien et al. 1986). 

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. 

Chlorpromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethasone, or dronabinol may be used for adult patients. Around the clock dosing should be considered. The choice of specific agent should based on patient specific factors, including potential for adverse drug reactions, and cost. SSRIs are effective for breakthrough nausea and vomiting but they are not superior to the less expensive antiemetics above. 

The severe nausea and vomiting induced by cytotoxic drugs and radiation in man can be reduced by metoclopramide given either atone or in combination with other drugs, such as dexamethasone. However, the extrapyramidal side-effects induced by metoclopramide, due to antagonism of dopamine re-... 

Metoclopramide is ineffective in motion sickness, as it acts selectively on the chemoreceptor trigger zone. Metoclopramide is effective in treating vomiting associated with gastroduodenal, biliary and hepatic disease, and postoperative vomiting. 

Metoclopramide may have some potential value (10 mg orally or IV 30 minutes before each meal and at bedtime) in nausea and vomiting of a variety of etiologies (uncontrolled studies report 80% to 90% efficacy), including emesis during pregnancy and labor (5 to 10 mg orally or 5 to 20 mg IV or IM, 3 times a day). 

Prochlorperazine (Compazine, and others) can be effective for prevention of vomiting due to cancer chemotherapy, but is generally less so than dexamethasone or metoclopramide. Phenothiazines can cause orthostatic hypotension, sedation, dystonic reactions, and akathisia. 

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. 

Increase the metoclopramide dose to 10 mg four times a day and consider changing to the intravenous route, particularly if Mrs CR is continuing to vomit. The administration of metoclopramide orally will be inappropriate if she is unable to retain oral medications due to sickness. 

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