Reglan

Overview of Reglan

Reglan is the trade name for the medication metoclopramide, which is primarily used to treat certain conditions of the stomach and intestines. It is a prokinetic agent that increases muscle contractions in the upper digestive tract, thereby accelerating the rate at which the stomach empties into the intestines. Reglan is available by prescription only and comes in several forms, including tablets, orally disintegrating tablets, and injections.

Indications for Use

This medication is indicated for the short-term treatment of gastroesophageal reflux disease (GERD) in certain patients who do not respond to other therapy. It is also used to treat slow gastric emptying in diabetes patients (diabetic gastroparesis), which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals. Additionally, it is sometimes used to prevent nausea and vomiting caused by chemotherapy or surgery, and to facilitate small bowel intubation by hastening gastric emptying.

Pharmacological Mechanism

Reglan works by blocking dopamine receptors and increasing the release of acetylcholine in the gastrointestinal tract, leading to enhanced motility without affecting gastric, biliary, or pancreatic secretions. Its antiemetic properties are a result of its antagonistic effect on dopamine receptors in the chemoreceptor trigger zone of the central nervous system.

Dosage and Administration

Dosage of Reglan should be individualized according to the patient’s response and clinical condition. Oral doses for GERD are typically 10-15 mg up to four times daily, taken 30 minutes before meals and at bedtime. For diabetic gastroparesis, the usual dosage is 10 mg taken 30 minutes before each meal and at bedtime for two to eight weeks. Dosage may vary for other conditions and for IV or IM administration. It is crucial to adhere to the prescribed regimen and duration of treatment.

Dosage Forms and Strengths

Reglan is available as a 5 mg or 10 mg round, white, scored, film-coated tablet. The orally disintegrating tablets come in the same strengths and dissolve on the tongue without the need for water. The injectable form of Reglan is available in both single-dose and multiple-dose vials, concentrated at 5 mg per mL.

Side Effects and Precautions

Common side effects may include feeling restless, sleepy, tired, dizzy, or experiencing headache and confusion. Serious side effects can occur and may include Tardive Dyskinesia, a serious movement disorder that is often irreversible. The risk of developing Tardive Dyskinesia increases with the duration of treatment and the total cumulative dose. Use in patients with underlying neurological conditions should be approached with caution, and it is generally recommended that treatment does not exceed 12 weeks. Other rare but serious effects can include Neuroleptic Malignant Syndrome, depression, and hypertension.

Drug Interactions

The therapeutic effect of Reglan may be impaired by anticholinergic drugs and narcotic analgesics. Concomitant use with monoamine oxidase inhibitors could result in hypertensive crisis. Combining Reglan with alcoholic beverages or other central nervous system depressants may have additive effects and worsen sedation. Additionally, caution should be taken when using it alongside sedatives or medications used to treat hypertension.

Contraindications

Reglan is contraindicated in individuals who have a history of hypersensitivity to metoclopramide or any components of the preparation. It should not be administered to patients with pheochromocytoma, epilepsy, or gastrointestinal hemorrhage, obstruction, or perforation, because it may stimulate motility, leading to potential dangerous effects. The patient’s full medical history should be assessed to evaluate the presence of any contraindications before initiating treatment with Reglan.

Pregnancy and Lactation

Use of Reglan in pregnant women should be undertaken only if the potential benefits justify the risks to the fetus. Metoclopramide is classified as category B for pregnancy according to the FDA. It should be used during pregnancy only if clearly needed. Moreover, Reglan is excreted in human milk; thus caution should be exercised when administered to a nursing mother, taking into account the importance of the drug to the mother.

Safety and Efficacy in Pediatric Use

The safety and effectiveness of Reglan in pediatric patients have not been established. It should not be used in children except in rare circumstances where the benefits might outweigh the risks. Pediatric dosage must be carefully calculated based on body weight, and close monitoring is required to adjust dosage as necessary.

Monitoring and Laboratory Tests

Ongoing monitoring is crucial while on Reglan therapy, including observations for signs of tardive dyskinesia. Blood pressure, liver enzymes, and kidney function may be tested at baseline and periodically during treatment, to monitor side effects and the drug’s efficacy. If there are clinical signs of depression, it is also beneficial to monitor the mental status of the patient comprehensively.

Overdose Management

In case of overdose, symptomatic treatment, along with immediate medical intervention, is crucial. Treatments for overdose include removing unabsorbed metoclopramide, supportive measures, and continuous monitoring to detect possible arrhythmias. There is no specific antidote for metoclopramide overdose, and hemodialysis or peritoneal dialysis are not likely to be effective in removing it from the blood.

Patient Counseling Information

Patients should be informed of the potential for developing tardive dyskinesia, as well as other serious side effects. They should be counseled to report any involuntary movements of the face, lips, or limbs immediately. They should also be advised to not consume alcohol, operate machinery, or perform any task that requires alertness until they are certain that Reglan does not affect their ability to perform these activities safely.