Neonatal Intensive Care UnitChildren's Hospital


Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



  • symptomatic management of gastrointestinal (GI) motility disorders and to treat gastroesophageal reflux disease


  • metoclopramide both blocks dopaminergic receptors and possesses peripheral cholinergic effects
  • its behavioral, motor and neuroendocrine effects are related to its anti-dopaminergic activity
  • metoclopramide's effects on the GI tract are believed to be related to enhancement of cholinergic excitatory processes; part of its effect on the GI tract may also be related to its anti-dopaminergic activity (in the GI tract dopamine is principally an inhibitory neurotransmitter)
  • effects on the GI tract include increased lower esophageal pressure, accelerated gastric emptying, increased peristalsis in duodenum and jejunum; metoclopramide may enhance colonic motility

Side Effects

  • dystonic reactions and extrapyramidal symptoms, which increase in frequency with higher doses and prolonged use
  • irritability, drowsiness, diarrhea, constipation
  • an iatrogenic overdose (1mg/kg q6h) caused methemoglobinemia in a neonate


  • history of seizure disorder (frequency and severity may be increased)
  • conditions in which stimulation of the GI tract may be dangerous (eg. gastrointestinal hemorrhage, mechanical obstruction or perforation, Hirschsprung's disease
  • pheochromocytoma

Nursing Implications

  • monitor gastric residuals


  • 0.03 to 0.1 mg/kg IV or po q8h
  • dilute IV solution to 1 mg/mL, give by slow infusion
  • dilute oral solution with water or feeds just prior to administration


  • 1 mg/mL syringe, for IV use, prepared by Pharmacy
  • 5 mg/mL, 2mL vial
  • 1 mg/mL oral liquid


  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
  3. Gomella TL (Ed): Neonatology - Management, Procedures, On-Call Problems, Diseases, Drugs, 1992, Appleton and Lange, Norwalk, Connecticut.
  4. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  5. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.
  6. Taeusch WH Ballard RA and Avery ME (ed): Schaffer and Avery's Diseases of the Newborn, WB Saunders Co, Toronto, Ontario; 6th Edition, 1991.
  7. Young TE and Mangum OB: Neofax - A Manual of Drugs Used in Neonatal Care, Columbus, Ohio: Ross Laboratories, 1992.

Last Uploaded: Thursday, 26-May-2011 00:53:43 EDT