Metoclopramide — NZ Medication Guide
📋 Reviewed by a Registered Pharmacist NZ — This information is for general educational purposes only and does not replace professional medical advice. Always consult your doctor or pharmacist before starting, stopping, or changing any medication.
What is Metoclopramide?
Metoclopramide is a dopamine antagonist and prokinetic agent used for nausea, vomiting, and gastroparesis. This medication is commonly prescribed in New Zealand and is funded by Pharmac for nausea and vomiting.
What is Metoclopramide Used For?
Metoclopramide is used for nausea and vomiting (including migraine-associated nausea, chemotherapy-induced nausea, and post-operative nausea), delayed gastric emptying (gastroparesis), and gastro-oesophageal reflux as a prokinetic agent.
How Does Metoclopramide Work?
Metoclopramide blocks dopamine D2 receptors in the CTZ (antiemetic effect) and enhances acetylcholine activity in the gastrointestinal tract (prokinetic effect), accelerating gastric emptying and small intestinal transit. It also sensitises the upper GI tract to acetylcholine.
How to Take Metoclopramide
Usually taken 30 minutes before meals and at bedtime. Standard dose is 10 mg three times daily. Short-term use is recommended (generally no longer than 5 days) due to the risk of extrapyramidal side effects with prolonged use. Available as tablets and injection.
Common Side Effects of Metoclopramide
- Drowsiness
- Restlessness (akathisia)
- Fatigue
- Diarrhoea
- Dry mouth
Serious Side Effects — Seek Medical Attention
Contact your doctor or call 111 immediately if you experience any of the following:
- Acute dystonic reactions (muscle spasms, particularly in young women and children — seek urgent medical care)
- Tardive dyskinesia (involuntary repetitive movements — with prolonged use)
- Neuroleptic malignant syndrome (rare)
- QT prolongation
- Hyperprolactinaemia (raised prolactin — causing galactorrhoea, menstrual irregularities)
Drug Interactions
Metoclopramide may interact with other medicines. Always inform your doctor and pharmacist of all medications, supplements, and herbal products you are taking. Key interactions include:
- Opioid analgesics (reduce prokinetic effect)
- CNS depressants (additive sedation)
- Levodopa and dopamine agonists (antagonised by metoclopramide)
- MAOIs
- Anticholinergic medicines
New Zealand Prescribing Information
Metoclopramide hydrochloride (10 mg tablets and 10 mg/2 mL injection) is funded by Pharmac in New Zealand. Due to the risk of extrapyramidal side effects — particularly tardive dyskinesia with long-term use — Medsafe and international regulators recommend limiting treatment to 5 days for acute nausea. Patients aged under 20 years are at particularly high risk of acute dystonic reactions.
Frequently Asked Questions
What are extrapyramidal side effects?
These are movement-related side effects caused by dopamine receptor blockade in the brain. They include muscle spasms of the neck or face (acute dystonia), restlessness (akathisia), slow stiff movements (parkinsonism), and — with long-term use — involuntary repetitive movements (tardive dyskinesia). If you notice any unusual movements, contact your doctor.
Can I use metoclopramide for gastroparesis long-term?
Long-term use is generally discouraged due to the risk of tardive dyskinesia. For chronic gastroparesis, your doctor will discuss the risk-benefit ratio carefully. Regular review and use of the lowest effective dose are important if longer-term treatment is needed.
⚠️ Disclaimer: This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or a qualified health provider with any questions you may have regarding a medical condition or medication. In New Zealand, medication availability and funding may vary — check with Pharmac or your pharmacist for the most current information.
Reviewed by a Registered Pharmacist NZ
References & Further Information
The following New Zealand and international resources were used to inform this page: