What does reglan do?

Metoclopramide (MET uh CLO prah mide) is the generic name for Reglan®. This medicine is used to treat gastroesophageal reflux (GERD or reflux) or delayed gastric (stomach) emptying. It also treats or prevents nausea and vomiting. Symptoms should go away in 1 to 3 days after starting treatment.

How This Medicine Works

It improves muscle movement of the food tube (esophagus) and the stomach. It also tightens the muscle between the esophagus and stomach (Picture 1). This decreases the chance of food coming back up. Metoclopramide also helps to strengthen the stomach muscle so food can move into the intestine faster.

  • Reglan® tablets and syrup start working 30 to 60 minutes after being taken. The effects last several hours.

  • The doctor will have you give the medicine 3 or 4 times per day:

    • 3 times a day – (when possible) Give it 30 minutes before meals (breakfast, lunch and dinner).

    • 4 times a day – (when possible) Give it 30 minutes before meals and once at bedtime.

Drug – Nutrient Interactions

This medicine should not be taken with these other medicines:

  • Sertraline (Zoloft®)

  • Cimetidine (Tagamet®)

  • Monoamine oxidase inhibitors

  • Levodopa

  • (MAOI’s for depression)

  • Tacrolimus (Prograf®, Protropic®)

  • Digoxin (Lanoxin®)

  • Cyclosporine (Neoral®, Sandimmune®)

If your child is taking any other medicine, Kava Kava, or other herbal supplements, tell your doctor and pharmacist. Certain medicines should not be taken with pain medicines, sedatives or seizure medicines.

How to Give This Medicine

  • Use a pediatric measuring device (available at the pharmacy) or a measuring spoon to measure the exact dose (Picture 2). Do not measure liquid medicines in kitchen spoons.

  • Read the label carefully and make sure you are giving your child the right dose. It is easy to confuse the many different dosage forms and strengths.

  • Give the exact dose of medicine that your doctor ordered.

  • Stay with your child until he or she has swallowed the dose of medicine.

  • It is very important to give the medicine every day as ordered, even if your child is feeling fine. Do not change doses or stop the medicine without talking to your child’s doctor.

If You Forget to Give a Dose

If you forget to give a dose of this medicine, but remember within about an hour, give it right away. Then go back to your regular dosing schedule. If you do not remember until later, do not give the missed dose at all and do not double the next one. Instead, go back to your regular dosing schedule. If you have any questions about this, check with your child’s doctor or pharmacist.

If a Dose Is Vomited

  • If your child gags or chokes and spits out the dose before swallowing it, let the child calm down and then give the same amount one more time.

  • Even if the medicine is vomited (thrown up) right after it is given, some of the medicine may still be in the stomach. Do not repeat the dose unless it is in tablet form and you can see the whole tablet was vomited.

  • If the liquid form is vomited (thrown up) right after you give it, do not repeat the dose. Some of the medicine may still be in the stomach. The vomiting might be due to the strong taste of the medicine. For the next scheduled dose, try giving the medicine in applesauce or jelly. If the vomiting continues, call your child’s doctor.

Warnings

  • If your child is allergic to metoclopramide, he or she should not take this medicine.

  • This medicine can cause seizures. Let your child’s doctor know of a history of seizures.

  • Let your child’s doctor know of any history of poor kidney function or depression. The dose may need to be decreased.

Extrapyramidal(EX trah peer AM ih dahl)Side Effects

Sometimes Reglan® will cause unusual side effects called Extrapyramidal Side Effects (EPSE). These side effects are muscle spasms the child cannot control. The child may:

  • Turn his eyes upward.

  • Appear to have a stiff or “locked” jaw.

  • Have trouble talking or moving his mouth and tongue.

  • Bend or twist his neck to one side.

  • Arch his back (bend backwards) because of a muscle spasm in the back.

  • These effects can also occur after the medicine has been stopped. This is more likely in patients who take it for a long time (more than 3 months). The effects may be permanent, and there is no treatment.

If any of these EPSE reactions occur, stop giving the medicine and contact your child’s doctor.

Special Note for Female Patients

  • If a patient thinks she might be pregnant, she should tell the doctor before she begins taking this or any medicine.
  • If a patient is breast-feeding her baby, she should tell her doctor before she begins taking this or any medicine.

Possible Side Effects

  • Drowsiness, tiredness
  • Restlessness
  • Seizures
  • Constipation or diarrhea
  • Rash
  • Swelling (especially hands and feet)
  • Extrapyramidal side effects (see box above)

What to Do about Side Effects

  • If a skin rash occurs, stop giving the medicine and call your child’s doctor.
  • If your child becomes drowsy or sleepy, do not let him ride a bike or operate machinery (such as a lawnmower or car) or take part in any activities where he must stay alert and awake.

Signs of Overdose

Stop giving the medicine and call your child’s doctor if you see either of these signs of overdose:

  • Severe drowsiness

  • Confusion

When to Call the Doctor

Call your child’s doctor if your child has:

  • Extrapyramidal side effects (see information box on page 3).

  • Any side effects that continue or are very bothersome.

  • Signs of an overdose.

Medicine Storage

  • Store all medicine out of the reach of children.

  • Always keep medicine in the original bottle from the pharmacy.

  • Do not keep this medicine in the refrigerator. Store at room temperature.

  • Light and moisture make this medicine not work as well. Keep the bottle tightly closed and store it in a dark, dry place (not in the bathroom or above the kitchen sink).

  • Keep this medicine away from heat or direct sunlight.

  • When this medicine is no longer needed, dissolve the leftover medicine in water or rubbing alcohol. Mix the dissolved medicine with an unwanted material (like coffee grounds). Then, place the mixture back in the pill container or in another container that will not leak. Throw the container away in the trash where children and pets cannot reach it.

Other Advice about the Medicine

  • Ask your pharmacist for two labeled bottles if your daycare provider will be giving this medicine.
  • Important: Get this prescription refilled at least 2 days before the last dose is given.
  • Some pharmacies may not have this medicine. Please ask your nurse to call your pharmacy before you leave the hospital to see if they have this medicine or can order it for you. You may also have the prescription filled at the Nationwide Children’s Hospital Pharmacy.
  • If your child has trouble taking medicine, ask your nurse for Helping Hand HH-IV-28: medication by mouth.
  • Tell your child’s doctor and pharmacist if your child has ever had a strange or allergic reaction to any medicine.
  • Do not stop giving this medicine or change the amount given without first talking with your child’s doctor or pharmacist. Stopping the medicine allows symptoms to come back. Increasing the dose can be dangerous.
  • If you carry medicine in your purse, keep it in its childproof bottle and keep your purse out of the reach of children.
  • Bring all your child’s medicines with you in the original bottles whenever your child sees a doctor, goes to an emergency room or is admitted to the hospital. This helps doctors who may not know your child.
  • Learn the name, spelling and dose of this medicine. Teach your child also, if he is old enough. You need to know this information when you call your doctor or pharmacist.
  • If your child takes too much of this medicine, or if someone else takes this medicine, first call the Central Ohio Poison Center at 1-800-222-1222 (TTY 614-228-2272). They will tell you what to do.
  • The doctor has prescribed this medicine for your child only. Do not give it to anyone else.
  • Tell your child’s teacher, school nurse, coach, babysitter and others your child is taking this medicine and what side effects to watch for.
  • Your child’s school will need a note from you and from the doctor if the medicine is to be given at school by the school nurse.

Follow-Up Visits

  • You can expect to have regular follow-up visits with your child’s doctor.

  • Write down all your questions as you think of them. Bring this list with you when you see the doctor.

  • Be sure to call the doctor if you cannot keep the appointment.

If you have any questions, be sure to ask your child’s doctor, nurse or pharmacist.

Metoclopramide (Reglan®) (PDF)

HH-V-29 9/92 Reviewed 5/15 Copyright 1992, Nationwide Children’s Hospital

Reglan

Brand Names: Metozolv ODT, Reglan

Generic Name: metoclopramide (oral/injection)

  • What is metoclopramide (Metozolv ODT, Reglan)?
  • What are the possible side effects of metoclopramide (Metozolv ODT, Reglan)?
  • What is the most important information I should know about metoclopramide (Metozolv ODT, Reglan)?
  • What should I discuss with my healthcare provider before using metoclopramide (Metozolv ODT, Reglan)?
  • How should I use metoclopramide (Metozolv ODT, Reglan)?
  • What happens if I miss a dose (Metozolv ODT, Reglan)?
  • What happens if I overdose (Metozolv ODT, Reglan)?
  • What should I avoid while taking metoclopramide (Metozolv ODT, Reglan)?
  • What other drugs will affect metoclopramide (Metozolv ODT, Reglan)?
  • Where can I get more information (Metozolv ODT, Reglan)?

What is metoclopramide (Metozolv ODT, Reglan)?

Metoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines.

Metoclopramide oral (taken by mouth) is used for 4 to 12 weeks to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief.

Metoclopramide oral is also used to treat gastroparesis (slow stomach emptying) in people with diabetes, which can cause heartburn and stomach discomfort after meals.

Metoclopramide injection is used to treat severe diabetic gastroparesis. The injection is also used to prevent nausea and vomiting caused by chemotherapy or surgery, or to aid in certain medical procedures involving the stomach or intestines.

Metoclopramide may also be used for purposes not listed in this medication guide.

What are the possible side effects of metoclopramide (Metozolv ODT, Reglan)?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking metoclopramide and call your doctor at once if you have any of these SIGNS OF A SERIOUS MOVEMENT DISORDER, which may occur within the first 2 days of treatment:

  • tremors or shaking in your arms or legs;
  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); or
  • any new or unusual muscle movements you cannot control.

Call your doctor at once if you have:

  • confusion, depression, thoughts of suicide or hurting yourself;
  • slow or jerky muscle movements, problems with balance or walking;
  • mask-like appearance in your face;
  • a seizure;
  • anxiety, agitation, jittery feeling, trouble staying still, trouble sleeping;
  • swelling, feeling short of breath, rapid weight gain; or
  • severe nervous system reaction–very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Common side effects may include:

  • feeling restless;
  • feeling drowsy or tired;
  • lack of energy;
  • nausea, vomiting;
  • headache, confusion; or
  • sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about metoclopramide (Metozolv ODT, Reglan)?

Do not use this medicine if you’ve ever had muscle movement problems after using metoclopramide or similar medicines, or if you’ve had a movement disorder called tardive dyskinesia. You also should not use metoclopramide if you’ve had stomach or intestinal problems (a blockage, bleeding, or a hole or tear), epilepsy or other seizure disorder, or an adrenal gland tumor (pheochromocytoma).

NEVER USE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. The longer you use metoclopramide, the more likely you are to develop this movement disorder. The risk of this side effect is higher in diabetics and older adults (especially women).

Call your doctor at once if you have uncontrollable muscle movements in your lips, tongue, eyes, face, arms, or legs.

ATI-drugs – ATI pharm Prep

System Drug Name Important Information

Heart – Failure Digoxin (cardiac glycoside, used to treat dysrhythmias and heart failure)

● Therapeutic Levels 0.5-0.8 (Pg. 177) ● IV digoxin: infuse over AT LEAST 5min. ● WITHHOLD if HR LESS THAN 60/min ○ MUST auscultate apical pulse for one full minute ● Toxicity: Yellowing vision, blurry vision, anorexia, fatigue, weakness, N/V, GI effects, tinnitus, ● Narrow therapeutic range ● Positive inotrope (Increase force and efficiency of myocardial contraction), negative chronotrope (Decrease Heart rate) ● Hypokalemia leads to toxicity, hyper K leads to decreased effect ● Treatment is cholestyramine (BAR) or Digibind (FAB) ● To prevent “Digoxin-induced dysrhythmias, avoid hypokalemia and increased serum digoxin levels ○ Watch for n/v and general weakness. (hypokalemic) and caution with potassium supplements. ● Avoid any drug that affect potassium (loop diuretics, ACE Inh and ARBs)

Brain – seizure Phenytoin (hydantoin class, used to treat seizures)

● Therapeutic levels 10- ● Narrow therapeutic range ● Gingival hyperplasia (notify dentist, use soft brush); use of folic acid supplements decreases occurrence ● Hirsutism, acne ● Enzyme inducer- decreases effects of many drugs ● Serum level increased when used with valproic acid or methylphenidate ● Toxic levels include nystagmus, ataxia, sedation, double vision, cognitive impairment ● Do not take with milk, decreases absorption of Vit D and Calcium ● May cause thrombocytopenia ● Check LFT’s ● Stop med if skin rash occurs ● Infuse no faster than 50mg/min to decrease dysrhythmias and hypotension ● Encourage clients to consume adequate amounts of calcium and vit D

Brain – seizure Carbamazepine ● Therapeutic levels: 4- ● Hepatic Autoinducer- oral contraceptives and warfarin ● Blood dyscrasias (leukopenia, anemia, thrombocytopenia, bone marrow suppression) /pancytopenia ● Stimulates posterior pituitary and promotes secretion of ADH so hypo- osmolarity – essentially a medication induced SIADH ● Can cause SJS (treat minor reactions with antihistamine, wear sunscreen, and notify provider) ● GI distress, drowsiness, rash, nystagmus, double vision, vertigo, staggering ● gait, and headache ● Start with low dose and titrate up

● Administer at bedtime ● Obtain baseline CBC and platelets, and perform ongoing monitoring ● Observe for indications of bruising and bleeding of gums ● Monitor for sore throat, fatigue, or other indications of infection ● Hepatotoxicity- Evidenced by anorexia, nausea, vomiting, fatigue abdominal pain, and jaundice

Brain – seizure Valproic Acid ● Monitor liver and pancreatic enzymes due to damage ● Can be used in any type of seizure ● Hepatotoxicity- anorexia, nausea, vomiting, jaundice, abdominal pain, fatigue ● Pancreatitis- nausea, vomiting, abdominal pain ● Thrombocytopenia- bruising; monitor platelet count ● Teratogenic ● Enzyme inhibitor ● N/V, indigestion- take with food ● Weight gain

Chemo Methotrexate ● Used in chemotherapy, psoriasis, rheumatoid arthritis ● Interrupts cell production, so monitor for bleeds in GI/mucosa/gums. Use soft brushes. Protect skin. ● Pregnancy Cat X (stops cell production) and is used to dissolve pregnancy. Moms need to be on strict birth control. ● Don’t give with folic acid ● Give with leucovorin (prevents side effects) ● Due to immunosuppression, report fever to provider stat ● Dosed weekly ● Sores in mouth (stomatitis) indicates toxicity.

Diuretic Mannitol (Osmotic diuretic)

● Adverse effects: Peripheral edema, Pulmonary edema (can potentiate HF) ● ↓ intracranial and intraocular pressure – used in glaucoma ● Lung crackles should be recognized as an indicator of potential complications

GI Sucralfate (Mucosal Protectant)

● Protects mucosa (ulcers) ● Causes constipation, so teach patients to increase fiber and fluid

Pain Morphine Sulfate ● Primary use is analgesia ● Teach patients about side effects: ○ Respiratory Depression ○ Constipation ○ Orthostatic Hypotension ○ Urinary Retention ○ Can cause biliary colic

Diuretic Acetazolamide (Carbonic

● Diuretic – carbonic anhydrase ● Used to decrease IOP in glaucoma patients

GI Senna ● Stimulant laxative

DM Insulin Aspart ● Rapid acting ● 15 – 30 minutes onset ● 3 – 5 hour duration

DM Lispro ● Rapid acting ● ONSET: 15 to 30 min ● PEAK: 0.5 to 2.5 hr ● DURATION: 3 to 6 hr

DM Insulin Regular (Short-Acting)

● 30 – 60 min onset ● 4 – 6 hours duration ● Always draw the short-acting insulin before a long-acting insulin.

DM Insulin NPH (Intermediate- Acting)

● Onset 1- 2hr ● Peak 6 – 14hr ● Inject air into NPH, Inject air into R, Draw R, draw NPH. ● NPH comes second, because he’s a gentleman. ● Cloudy appearance ● Administer subcutaneous only

DM Insulin Glargine (Long-Acting)

● No peak ● Do NOT mix it with anything else in syringe. ● Clear appearance

Heart – HTN Enalapril ● Class: Ace-inhibitors (-pril) ● Watch for dry cough and hyperkalemia (normal range 3.5-5 mEq/L) ○ If cough excessive, next choice often ARB (-sartan suffix) ● Hyperkalemia is a result of the excretion of Na+ and H2O, and retention of K+ by the kidneys.

Pain Aspirin ● DO NOT GIVE TO CHILDREN – causes Reye’s syndrome. ● Watch for acute salicylate poisoning evidenced by tinnitus. ● Toxic levels cause GI distress, anorexia, and acidosis compensated by hyperventilation. ● Don’t give concurrently with other anticoagulant therapy (heparin, warfarin, etc)

Blood Heparin ● Anticoagulant ● Antidote is Protamine Sulfate ● Monitor platelet count (less than 100,000 can indicate HIT, do NOT administer) ● Monitor aPTT (normal/control is 30 sec, therapeutic range 45-75 sec) ● Given subQ(within 2cm of umbilicus): do NOT massage site, risk for hemorrhage ● Apply gentle pressure ● Overdose sign: blood in urine, bruising, hematoma, hypotension, tachy. ● May cause hyperkalemia

Preggers Mag Sulfate ● Uses: laxative, anti-convulsant for labor & delivery, tocolytic to stop preterm labor. ● ADRs: weak, flaccid muscles, painful muscle contractions ● Monitor blood pressure, heart rate, respiratory rate when IV ● Assess signs of toxicity: ○ Depressed CNS/level of consciousness ○ depressed or absent deep tendon reflexes ○ Antidote: calcium gluconate

Cancer Tamoxifen ● Estrogen receptor blocker (Karboski had us learn Raloxifene) ● Stops breast cancer growth, so used in that tx ● CAUSES endometrial cancer, hypercalcemia, N/V, pulmonary embolism, hot flashes, vaginal discharge, menstrual irregularities, bruising ● Anti-estrogenic-used in pre+post menopausal women ● Cardiovascular ADRs: chest pain, development of thrombus

Cancer Anastrozole ● Aromatase inhibitor ● Stops breast cancer growth, for postmenopausal women

Cancer Trastuzumab ● Tx for metastatic breast cancer, used with paclitaxel

Brain – benzo Diazepam ● Benzodiazepine Antidote: Flumazenil (ATI seems to love this FYI) ● Do not take w/ alcohol

Metabolism – Muscles

Neostigmine ● Used in tx for Myasthenia gravis ● Prevents the inactivation of acetylcholine, thereby increasing the amount of Ach at the receptor sites. ● ADR: excessive muscarine stimulation AEB increased GI motility, increased GI secretions, pupillary constriction, bradycardia. Can also cause nausea. ● ADR: Cholinergic crisis (excess stimulation and respiratory depression) ● Managing the ADRS: For both, administer ATROPINE – it counteracts the negative effects of Neostigmine. ● Monitor respiratory function – if your patient is in respiratory arrest atropine won’t help, you’ll need to mechanically ventilate your patient ● Patients are started at low doses and slowly titrated up

Brain – cognitive Donepezil ● Used for tx in both Parkinson’s and Alzheimer’s

Heart – Failure Procainamide ● Used to treat dysrhythmia (class 1a, sodium channel blockers) ● Can cause neutropenia, thrombocytopenia, cardiotoxicity, hypotension ● Can cause SLE like symptoms

Heart – failure Amiodarone ● Used to treat dysrhythmia (class 3, potassium channel blocker) ● Can cause pulmonary toxicity, bradycardia, AV block, visual disturbances, liver problems ● Gives blue-gray discoloration to skin ● Biological half life of 58 days so it stays in you for a long time

Blood Paclitaxel ● Class: antineoplastic agent ● Indications: breast cancer, non-small cell lung cancer, ovarian cancer (among others) ● Common ADRs: alopecia, nausea/vomiting, diarrhea, anemia, myalgia, peripheral neuropathy ● Serious ADRs: atrial fibrillation/serious cardiac issues, SJS, N/V and anemia that interferes with ADLs

Cancer Fluoruoracil ● Cancer therapy: antimetabolite (also called 5-FU)

Cancer Vincristine Cancer therapy: plant alkaloid

Cancer Cysplatin Cancer therapy: Alkylating agent

Cancer Decadron Cancer Therapy: steroid

Metabolism – antidote

Atropine sulfate ● Cholinergic antidote

Brain – antidote Flumenazil ● Benzo antidote

Pain – antidote Acetylcysteine ● Acetaminophen/salicylism OD antidote

Blood – antidote Protamine Sulfate ● Antidote used to reverse heparin

Blood – antidote Vitamin K (phytonadione)

● Used to create clotting factors 2,6,9,10, ● Used to reverse warfarin

Pain – antidote Naloxone ● Opioid reversal / Mu antagonist

Brain – Depression Fluoxetine ● SSRI class (brand name Prozac) ● Therapeutic effect between 1 and 4 weeks ● Do not take with St John’s Wort: increased risk for SEROTONIN SYNDROME (hallucinations, hyperreflexia, excessive sweating, fever) ● Suppresses platelet aggregation and increase risk of bleeding ● Take acetaminophen, not NSAIDs

Airway – Asthma Montelukast ● Seasonal allergies in kids ● Leukotriene modifier for long term prophylaxis

● Can cause suicidal ideation

Airway – Asthma Albuterol ● Rescue inhalers, toxicity associated with Tachycardia and jitteriness because it is a beta agonist (like epinephrine)

Airway – Asthma Salmeterol/ Formoterol

● Long-acting beta agonist (bronchodilator) ● Given with a steroid

Airway – Asthma Beclomethasone ● Prophylactic glucocorticoid ● Administered on a fixed schedule ● Not for PRN ● Administer Short acting beta agonist first before administering glucocorticoid to open up airway ● Rinse mouth out afterward to prevent oral candidiasis/dental caries

Airway – Asthma Nedocromil (cromolyn sodium)

● Mast cell stabilizer, long term prevention of asthma symptoms and preventative treatment prior to exercise or known allergy. ● May experience unpleasant taste (tastes like chrome) ● Asthma Drug ● Mast Cell Stabilizer – Mast cells release histamine which causes bronchoconstriction ● Long-term control medication ● Use 10-15 mins before exercise

Antibiotic Metronidazole (Antibiotic)

● Used for protozoal and anaerobic bacterial infections ● Causes metallic taste in pt mouth, nausea, dark urine ● Toxicity causes ataxia and CNS effects; ataxia, seizures, vertigo ● Monitor for pseudomembranous colitis ● Contraindicated during 1st trimester, caution during second two. ● Don’t mix with ETOH (causes a disulfiram-like reaction) ● Can lead to increased levels of ○ Warfarin ○ Phenytoin ○ lithium

Antibiotic Cefazolin ● 1st Generation Cephalosporin-Parenteral ● Contraindicated in patients with an allergy to PCN’s.

Brain – antidote Diphenhydramine ● Benadryl, antihistamine ● Can give as antidote for dystonia

Metabolism – Hydroxyzine ● Vistaril ● Antihistamine ● Anticholinergic side effects ● Decrease anxiety, prevent insomnia, relieve nausea/vomiting

GI Ferrous Sulfate (Iron)

● Take with orange juice on empty stomach to increase absorption ● Stains everything

breath, pain, and fever; These symptoms indicate an acute allergic reaction and warrant immediate discontinuation of drug therapy

Linezolid ● Antibiotic good against MRSA & VRE, NOT C. Diff.

Baclofen ● Used in treatment for multiple sclerosis ● Enhances GABA to relieve muscle spasticity. ● Causes nausea, constipation, urinary retention, seizures

Chlordiazepoxide ● Benzodiazepine ● Enhances GABA (inhibitory NT) to prevent seizures from delirium tremens ● Alcohol Withdrawal

Amoxicillin ● Aminopenicillin- note PCN allergies ● oral admin only, take with a meal.

Epoetin alpha ● Used in tx of anemia, stimulates RBCs (look at hgb and hct for effectiveness) ● Increases hematocrit which can lead to HTN, DVT, headache ● Can lead to increased blood pressure

Ca+ Channel Blocker

Verapamil ● Calcium channel blocker ● Causes digoxin toxicity ● Negative inotrope ● Used in A-Fib, angina, SVT ● ADR: Orthostatic hypotension

Antilipidemic Atorvastatin ● Reduce LDL ● Raise HDL ● Hepatotoxicity ● Causes myopathy (do NOT give with fibrates gemfibrozil or fenofibrate) ● Taken for LIFE

Thrombopoietic Growth Factor

Oprelvekin ● Increases platelets ● Causes fluid retention, dysrhythmias, inflammation of eye/blurred vision ● Contraindicated in bone marrow cancer due to stimulation of tumor

filgrastim ● Used during chemotherapy ● A leukopoietic growth factor – stimulates bone marrow the produce neutrophils ● ADR: bone pain ○ Notify provider and give opioids ● Leukocytosis ○ Decrease dose or d/c if WBC count exceeds 10K ● Splenomegaly with long term use ○ Evaluate reports of upper left quad abdominal pain ● Monitor CBC every 2 weeks

Sargramostim ● Stimulates growth of monocytes and granulocytes ○ Neutropenic tx ● Used in bone marrow transplants ● Sargra(granulocytes)mo(monocytes)stim(stimulation)

Amphotericin B ● Antifungal ● Amphoterrible for your kidneys, ○ Get BUN and creatinine baseline ○ Can cause oliguria ● Causes infusion reaction so IV bolus before and after ○ Look for fever, chills, nausea ○ Premedicate with acetaminophen, diphenhydramine, glucocorticoid ● Causes hypokalemia ● Causes bone marrow suppression ○ Get CBC baseline

SMX/TMP (trimethoprim/ sulfamethoxazole)

● Drink with 8 to 10 glasses of water per day to decrease damage from crystallization ● Can cause a rash that MUST be reported to provider (SJS) ● Used for UTI’s ● Increases the effects of warfarin and thus increases the pt.’s risk for bleeding

Clavulanate/ Tazobactam/ Sulbactam

● Beta Lactamase Inhibitor

Clindamycin ● Miscellaneous antibiotic agent ● Increased risk of CDiff infection- monitor for watery diarrhea

Vasodilator Nitroglycerin ● Treats angina by dilating blood vessels to decrease venous return, thereby decreasing demand on the heart ● For treatment of an acute attack of prophylactic ● With transdermal patch, check blood pressure 1 hr after application ● Make sure patch is off for 12-14 hours before applying new one ● ADR: Reflex tachycardia upon abrupt d/c ○ Administer beta blocker ● Tolerance ○ Use the lowest dose to achieve effect ● Can give as anti-dote for hypertensive crisis caused by MAOI

Propranolol ● NON-Cardioselective Beta blocker (β1 & β2) so therefore it is contraindicated in asthma medication. ● How are you going to rescue someone with epi to bronchodilate if you’ve blocked the lung receptor?

Anticoagulant Clopidogrel ● Anticoagulant, put pt on bleeding precautions

Methadone ● Opiate treatment medication ● Partial agonist

Bupropion ● Lowers the seizure threshold ● Activating – can cause insomnia. Administer in the morning ● ADR: bradykinesia, change in vision and hearing ● Can be used for nicotine addiction

Captopril ● ACE Inhibitor ● Captopril should be taken 1 hr. Before meals. ● ADR: Neutropenia, rash (caps make me itchy)

Spironolactone ● Potassium Sparing Diuretic ● Blocks Aldosterone ● Usually combined with loop and thiazide ● Watch for hyperkalemia, metabolic acidosis ● EXTRA hyperkalemic effects when taken concurrently with an ACE inhibitor (-pril)

Rosuvastatin ● High potency statin

Disulfiram ● Give for alcohol addiction during recovery program. Creates unpleasant reaction to alcohol.

Modafinil ● Give for meth. addiction

Lithium ● Limit aerobic activity in hot weather ● Watch for coarse tremors, this means toxicity ● Encourage 2,000 to 3,000 mL water per day ● Therapeutic level: 0.6-1.2.Toxic: 1.5+ ● Don’t give with NSAIDs. Aspirin and sulindac are okay though. ● No crash diets or fasting. Can lead to toxicity. ○ Opposite reaction with TOO much Na- leads to decreased absorption and sub-therapeutic levels

Felodipine ● “-dipine” suffix= calcium channel blocker ● Treats hypertension and stable angina ● Common ADR- edema. Contraindicated in HF patients.

Pain Fentanyl ● Opioid analgesic with rapid onset and short duration ● Common forms- patches, lollipop (both come up in practice tests) ○ Make sure to safely dispose of waste, fold the patch together, store the lolly sticks in the given receptacle

Celecoxib ● COX 2 inhibitor ● Last choice med due to increased risk of MI/stroke ● Contraindicated in pt with sulfonamide allergy

Pilocarpine ● Used to treat glaucoma and dry mouth

● When used for glaucoma, will take for entire life ● Can be absorbed through eye and have systemic ADRs ● Can cause transient brow pain that goes away 2 weeks after initial treatment. Interferes with vision.

Oxytocin ● Stop infusion when contractions last longer than 2 min each. ● Contractions 50 mmHg or greater should be reported and infusion DC’ed ● Contractions more frequent than 2-3 min indicate infusion DC ● Resting uterine contractions of 15-20+ mmHg indicates DC

Isotretinoin ● Used to treat severe nodular acne ● Pregnancy test before prescription is filled

Dopamine ● Catecholamine used to increase BP. ● Can be used to treat cardiogenic shock. It increases renal perfusion. Causes cardiac stimulation.

Anti-Angina Isosorbide mononitrate

● Nitrate: Treats and prevents chest pain. May result in hypotension; hold med if bp is below normal levels

Cyclosporine ● Immunosuppressant drug for organ transplant recipients: taken for the rest of their life ● Also used for RA and psoriasis ● Common ADRs: HTN, hirsutism, gingival hyperplasia, headache, tremor, burning sensation in eyes (if opthalmic) ● Serious ADRs: hyperkalemia, hepatotoxic, opportunistic infection, encephalopathy, nephrotoxicity ● Avoid: infected persons, potassium sparing drugs, grapefruit juice, live vaccines

Allopurinol (xanthine oxidase inhibitor)

● Anti gout medication (gout is painful form of arthritis, buildup of uric acid crystals in joint) ● Increase dose each week by 50 to 100 mg until max of 800 mg daily ● Interacts with warfarin and result in increased anticoag effect. ● Prolonged use can cause cataracts ● Can cause a metallic taste (normal) ● Drowsiness and nausea are expected side effects ● Increase water intake to prevent stone formation (2-3 L/day) ● Report red rash and fever

Anti-Inflammatory Colchicine ● Gout anti-inflammatory ● ADR: GI distress, thrombocytopenia, muscle pain/tenderness ● Grapefruit juice can increase ADRs

Omeprazole ● PPI; reduce gastric acid secretion. Used for gastric ulcers, GERD, and hypersecretory conditions, such as Zollinger-Ellison Syndrome. ● ADRs: headache, N/V/D (Short-term use); Long term use: Pneumonia, osteoporosis and fractures, rebound acid hypersecretion, and

Sedative/Hypnotic Zolpidem (Ambien)

● Indication: insomnia ● Common ADRs: dizziness, somnolence, nausea, visual disturbances ● Precautions: sleep driving, preparing/eating food, etc possible. Take at bedtime and avoid other CNS depressants (alcohol, anxiolytics) ● Only for short-term use!!

amantadine ● Antiparkinsonian drug ● Treats EPS

Ranitidine (Zantac) ● “-tidine” = H2 receptor agonist. Potent inhibitor of gastric acid secretion. ● Indications: GERD, ulcers, H. pylori, reflux, indigestion ● ADR: Pain, constipation, diarrhea, headache. Can cause jaundice

Epinephrine hydrochloride

● Indications: anaphylaxis, hypotension, MI/resuscitation, asthma ● Adverse effects: tachycardia, high blood pressure

Anti-Parkinson’s Benztropine ● Cogentin ● Treats parkinsonian adverse effect of antipsychotic medications ● Anticholinergic effects

Lactulose Laxative–excretes ammonia

Drugs that interfere with the effectiveness of oral contraceptives:

All anti-seizure drugs (Carbamazepine, Valproic Acid, Lamotrigine, Phenytoin)

2nd Generation Cephalosporin

Cefotetan Can cause a reaction similar to what disulfiram causes when patients take it and drink alcohol. THe reaction manifests as nausea, severe vomiting, headache, weakness, and hypotension.

Alpha Agonist Clonidine ● CNS depression ● Decreased cardiovascular effects (hypotension, bradycardia) ● Weight gain (exercise and eat well!) ● Never stop abruptly ● Avoid taking this med with high fat. ● Minimize diaphoresis during alcohol withdrawal

Trimethorprim/ Sulfamethoxazole (Bactrim) (SMX- TMP)

Increases the effects of warfarin and thus increases the patient’s risk for bleeding; use for UTI’s (drink fluids), SJS

Monobactam (Antibiotic)

Aztreonam A monobactam with no cross reactivity to other B-Lactams, should be used cautiously in pts. who have renal impairment; give to a Pt. w/ a PCN allergy

Antifungal Ketoconazole Azole-antifungal drug that can cause a temporary decrease in sexual hormone synthesis, resulting in gynecomastia, reduced libido, low sperm counts, and

menstrual irregularities

Immunosuppressa nt

Chloroquine Prevents malaria; causes photophobia, blurred vision, nausea, and diarrhea; take drug with food, wear sunglasses, and avoid driving while taking this!

Aminoglycoside (ATI) Macrolide (Karboski)

Erythromycin A macrolide that can cause ECG changes, including a prolonged QT interval and put the patient at risk for a potentially fatal ventricular dysrhythmia

Metoclopramide Central Dopamine Receptor Antagonist; Promotes gastric emptying, and antiemetic ADRs: Tardive dyskinesia, Dizziness, Fatigue, Sedation

Supplement Saw Palmetto Herbal supplement. Improves urinary health of men with BPH

Supplement Echinacea Improves flu-like symptoms

Supplement Gingko Memory

Supplement Ginseng Libido

Blood/ADH Hormone

Desmopressin Clotting promoter and anti-diuretic Can be used to treat Diabetes Insipidus. Monitor: creatinine clearance, serum osmolality, urine specific gravity

Cancer Pegfilgrastim Bone marrow stimulant Helps body make more WBCs after receiving cancer treatment

IV Equation Set Ups And Reversal Agents

Aa – Lab values platelet 150,000-450,

Aa – Lab values Neutrophil 1,500-8,

Aa – Lab values WBC 5,000-10,

Aa – Lab values BUN 10-

Aa – Lab values Serum Creatinine Men: 0.6 to 1. Women: 0.5 to 1.

Aa – Lab values Thyroid Stimulating Hormone (TSH)

0.3-5 microunits/mL

Aa – Lab values INR 2-

Aa – Lab values Potassium 3.5-

Aa – Lab values PT 18-24 seconds (pp 194);

Aa – Lab values aPTT 60-80 sec; on heparin okay to be 1.5-2x control

Aa – Lab values Na 135-

Aa – Lab values Cl 98-

Aa – Lab values HCO3 22-

Aa – Lab values AST ≤ 35

Aa – Lab values ALT ≤ 35

Aa – Lab values Alkaline Phos

Aa – Lab values Total Bili 0.1-1.

Aa – Lab values Direct Bili

Aa – Lab values Ca 9-10.

Aa – Lab values Mg 1.3 – 2.

Aa – Lab values PO4 3 – 4.

Aa – Lab values Glucose 70-

Aa – Lab values Lithium 0.5-1.

Aa – Lab values T3 3 ok

Aa – Lab values T4 65 ok

Aa – Lab values TSH 0.3 – 5.

Aa – Lab values 1oz 30mL

Aa – Lab values 1kg 2.2lb

Aa – Lab values Infiltration vs extravasation

Infiltration is a non vesicant fluid medication that leaks into surrounding tissues. Extravasation is a vesicant fluid medication that leaks into surrounding tissues. A vesicant fluid is one that causes blisters.

Aa – Lab values Conversions 1 mg = 1,000 mcg 1 kg = 1,000 g 1 oz = 30 mL 1 g = 1,000 mg

1 L = 1,000 mL 1 tsp = 5 mL 1 tbsp = 15 mL 1 tbsp = 3 tsp 1 kg = 2.2 lb 1 g = 1000 mg

SIDE EFFECTS

In general, the incidence of adverse reactions correlates with the dose and duration of metoclopramide administration. The following reactions have been reported, although in most instances, data do not permit an estimate of frequency:

CNS Effects

Restlessness, drowsiness, fatigue, and lassitude occur in approximately 10% of patients receiving the most commonly prescribed dosage of 10 mg q.i.d. (see PRECAUTIONS). Insomnia, headache, confusion, dizziness, or mental depression with suicidal ideation (see WARNINGS) occur less frequently. The incidence of drowsiness is greater at higher doses. There are isolated reports of convulsive seizures without clear-cut relationship to metoclopramide. Rarely, hallucinations have been reported.

Extrapyramidal Reactions (EPS)

Acute dystonic reactions, the most common type of EPS associated with metoclopramide, occur in approximately 0.2% of patients (1 in 500) treated with 30 to 40 mg of metoclopramide per day. Symptoms include involuntary movements of limbs, facial grimacing, torticollis, oculogyric crisis, rhythmic protrusion of tongue, bulbar type of speech, trismus, opisthotonus (tetanus-like reactions), and, rarely, stridor and dyspnea possibly due to laryngospasm; ordinarily these symptoms are readily reversed by diphenhydramine (see WARNINGS).

Parkinsonian-like symptoms may include bradykinesia, tremor, cogwheel rigidity, mask-like facies (see WARNINGS).

Tardive dyskinesia most frequently is characterized by involuntary movements of the tongue, face, mouth, or jaw, and sometimes by involuntary movements of the trunk and/or extremities; movements may be choreoathetotic in appearance (see WARNINGS).

Motor restlessness (akathisia) may consist of feelings of anxiety, agitation, jitteriness, and insomnia, as well as inability to sit still, pacing, foot tapping. These symptoms may disappear spontaneously or respond to a reduction in dosage.

Neuroleptic Malignant Syndrome

Rare occurrences of neuroleptic malignant syndrome (NMS) have been reported. This potentially fatal syndrome is comprised of the symptom complex of hyperthermia, altered consciousness, muscular rigidity, and autonomic dysfunction (see WARNINGS).

Endocrine Disturbances

Galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia (see PRECAUTIONS). Fluid retention secondary to transient elevation of aldosterone (see CLINICAL PHARMACOLOGY).

Cardiovascular

Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure and possible AV block (see CONTRAINDICATIONS and PRECAUTIONS).

Gastrointestinal

Nausea and bowel disturbances, primarily diarrhea.

Hepatic

Rarely, cases of hepatotoxicity, characterized by such findings as jaundice and altered liver function tests, when metoclopramide was administered with other drugs with known hepatotoxic potential.

Renal

Urinary frequency and incontinence.

Hematologic

A few cases of neutropenia, leukopenia, or agranulocytosis, generally without clear-cut relationship to metoclopramide. Methemoglobinemia, in adults and especially with overdosage in neonates (see OVERDOSE). Sulfhemoglobinemia in adults.

Allergic Reactions

A few cases of rash, urticaria, or bronchospasm, especially in patients with a history of asthma. Rarely, angioneurotic edema, including glossal or laryngeal edema.

Miscellaneous

Visual disturbances. Porphyria.

Read the entire FDA prescribing information for Reglan (Metoclopramide)

Generic Name: metoclopramide (MET oh KLOE pra mide)
Brand Names: Reglan

Medically reviewed by Sophia Entringer, PharmD Last updated on Jan 31, 2019.

  • Overview
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What is Reglan?

Reglan (metoclopramide) increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines and may help with nausea.

Reglan is used for 4 to 12 weeks to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief.

Reglan is also used to treat gastroparesis (slow stomach emptying) in people with diabetes, which can cause heartburn and stomach discomfort after meals.

Reglan may also be used for purposes not listed in this medication guide.

Important Information

Do not use Reglan if you’ve ever had muscle movement problems after using metoclopramide or similar medicines, or if you’ve had a movement disorder called tardive dyskinesia. You also should not use this medicine if you’ve had stomach or intestinal problems (a blockage, bleeding, or a hole or tear), epilepsy or other seizure disorder, or an adrenal gland tumor (pheochromocytoma).

NEVER USE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use can cause a serious movement disorder that may not be reversible. The longer you use metoclopramide, the more likely you are to develop this movement disorder. The risk of this side effect is higher in diabetics and older adults (especially women).

Before you take Reglan, tell your doctor if you have kidney or liver disease, congestive heart failure, high blood pressure, diabetes, Parkinson’s disease, or a history of depression.

Do not drink alcohol. It can increase some of the side effects of metoclopramide.

Stop using Reglan and call your doctor at once if you have tremors or uncontrolled muscle movements, fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing, depressed mood, thoughts of suicide or hurting yourself, hallucinations, anxiety, agitation, seizure, or jaundice (yellowing of your skin or eyes).

Before taking this medicine

You should not use Reglan if you are allergic to metoclopramide, or if you have:

  • tardive dyskinesia (a disorder of involuntary movements);

  • stomach or intestinal problems such as a blockage, bleeding, or perforation (a hole or tear in your stomach or intestines);

  • epilepsy or other seizure disorder;

  • an adrenal gland tumor (pheochromocytoma); or

  • if you’ve ever had muscle movement problems after using metoclopramide or similar medicines.

Tell your doctor if you have ever had:

  • liver or kidney disease;

  • problems with muscle movements;

  • congestive heart failure or a heart rhythm disorder;

  • high blood pressure;

  • seizures;

  • breast cancer;

  • Parkinson’s disease;

  • diabetes; or

  • depression or mental illness.

Tell your doctor if you are pregnant before taking metoclopramide.

It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.

Reglan is not FDA-approved for use by anyone younger than 18 years old.

How should I use Reglan?

Take Reglan exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Use the medicine exactly as directed.

Reglan should be taken for only 4 to 12 weeks.

NEVER USE REGLAN IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. The longer you use metoclopramide, the more likely you are to develop this movement disorder. The risk of this side effect is higher in diabetics and older adults (especially women).

Reglan is usually taken 30 minutes before meals and at bedtime, or only with meals that usually cause heartburn. Follow your doctor’s dosing instructions very carefully.

Do not use two different forms of metoclopramide (such as tablets and oral syrup) at the same time.

Store at room temperature in a tightly-closed container, away from moisture and heat. Keep the bottle tightly closed.

After you stop taking Reglan, you may have unpleasant withdrawal symptoms such as headache, dizziness, or nervousness.

Reglan dosing information

Usual Adult Dose of Reglan for Gastroesophageal Reflux Disease:

Oral: 10 to 15 mg up to 4 times a day 30 minutes before meals and at bedtime, depending upon symptoms being treated and clinical response. Therapy should not exceed 12 weeks.

Usual Adult Dose of Reglan for Gastroparesis:

During the earliest manifestations of diabetic gastric stasis, oral administration may be initiated. If severe symptoms are present, therapy should begin with IM or IV administration for up to 10 days until symptoms subside at which time the patient can be switched to oral therapy. Since diabetic gastric stasis is often recurrent, therapy should be reinstituted at the earliest manifestation.
Oral: 10 mg 4 times daily, 30 minutes before meals and at bedtime, for 2 to 8 weeks depending on clinical response.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include drowsiness, confusion, or uncontrolled muscle movements.

What should I avoid while taking Reglan?

Drinking alcohol with this medicine can cause side effects.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Do not take Reglan with other medications that increase the risk of experiencing extrapyramidal reactions (eg, spasms, muscle contractions, jerky/rigid movements).

Reglan side effects

Get emergency medical help if you have signs of an allergic reaction to Reglan: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking Reglan and call your doctor at once if you have any of these SIGNS OF A SERIOUS MOVEMENT DISORDER, which may occur within the first 2 days of treatment:

  • tremors or shaking in your arms or legs;

  • uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); or

  • any new or unusual muscle movements you cannot control.

Call your doctor at once if you have:

  • confusion, depression, thoughts of suicide or hurting yourself;

  • slow or jerky muscle movements, problems with balance or walking;

  • mask-like appearance in your face;

  • a seizure;

  • anxiety, agitation, jittery feeling, trouble staying still, trouble sleeping;

  • swelling, feeling short of breath, rapid weight gain; or

  • severe nervous system reactionvery stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Common Reglan side effects may include:

  • feeling restless;

  • feeling drowsy or tired;

  • lack of energy;

  • nausea, vomiting;

  • headache, confusion; or

  • sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Reglan?

Using Reglan with other drugs that make you drowsy can worsen this effect. Ask your doctor before you take opioid pain medication, a sleeping pill, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all your current medicines. Many drugs can interact with metoclopramide, especially:

This list is not complete and there are many other drugs that can interact with metoclopramide. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Reglan only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2020 Cerner Multum, Inc. Version: 12.01.

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More about Reglan (metoclopramide)

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