Metoclopramide (Maxolon tablets)

How does it work?

Maxolon tablets contain the active ingredient metoclopramide hydrochloride, which is a type of medicine called a dopamine antagonist. (NB. Metoclopramide is also available without a brand name, ie as the generic medicine.) Metoclopramide is an antisickness medicine, though it also has other uses due to its action on the gut.

Metoclopramide works primarily by blocking dopamine receptors found in an area of the brain known as the chemoreceptor trigger zone (CTZ). The CTZ is activated by nerve messages from the stomach when an irritant is present. It is also activated directly by agents circulating in the blood, for example anti-cancer medicines. Once activated, it sends messages to another area of the brain, the vomiting centre, which in turn sends messages to the gut, causing the vomiting reflex.

Blocking the dopamine receptors in the CTZ prevents nausea messages from being sent to the vomiting centre. This reduces the sensation of sickness and prevents vomiting.

Metoclopramide also acts in the upper end of the digestive system, where it enhances the action of a natural chemical called acetylcholine. Increasing the action of acetylcholine results in the tightening of the muscles at the entry to the stomach, relaxation of the muscles at the exit of the stomach and increased contraction of the muscles in the stomach itself. These actions speed the passage of food through the stomach into the intestine, which physically helps to prevent vomiting.

Both actions make metoclopramide useful in treating nausea and vomiting due to many causes, including anti-cancer chemotherapy and radiotherapy, various digestive disorders, heart failure, following surgery and anaesthetics, and in migraine.

Due to its action on the gut, metoclopramide also has several other uses. It is useful in migraine, not only for relieving nausea, but also because during a migraine attack stomach emptying is slowed, which can prevent painkillers from being absorbed. Metoclopramide speeds up the passage of painkillers from the stomach to the intestine, from where they are absorbed to relieve the headache.

Metoclopramide is often given before investigative procedures in hospital for its action on the gut, for example it helps to speed the passage of a barium meal through the gut.

Metoclopramide can also be used to restore normal muscle tone and function to the gut following surgery and in various digestive disorders. This helps relieve symptoms such as indigestion, pain, bile regurgitation, flatulence, acid reflux and heartburn.

What is it used for?

In adults over 20 years of age metoclopramide is used for the following conditions:

  • nausea and vomiting due to digestive disorders, anti-cancer chemotherapy, heart failure, deep X-ray or cobalt therapy and following general anaesthetics
  • relief of digestive symptoms such as indigestion, heartburn, flatulence, sickness, bile regurgitation and stomach pain due to conditions such as peptic ulcer, hiatus hernia, gallstones, reflux oesophagitis, or inflammation of the stomach or small intestine (gastritis or duodenitis)
  • relieving nausea and vomiting, and assisting the absorption of painkillers in migraine
  • to assist hospital investigative procedures on the gut (eg barium meal, duodenal intubation)
  • to help restore normal stomach emptying after surgery.

Use in patients under 20 years of age is not recommended and is restricted to the following conditions:

  • severe persistent vomiting where the cause is known
  • vomiting due to chemotherapy or radiotherapy
  • as an aid to hospital investigative procedures on the gut (gastro-intestinal intubation)
  • as part of a pre-med before an operation to prevent nausea and vomiting.

How do I take it?

  • The usual dose of metoclopramide for adults is one tablet taken three times a day. However, it is important to follow the instructions given by your doctor. These will be printed on the dispensing label that your pharmacist has put on the packet of medicine.
  • Metoclopramide can be taken either with or without food.

Warning!

  • This medicine may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
  • Metoclopramide can increase the rate of absorption of alcohol and increase its blood level and effects. You should avoid drinking alcohol while you are taking this medicine.
  • If vomiting persists despite taking this medicine you should consult your doctor.

Use with caution in

  • Children or young adults under 20 years of age (Maxolon tablets are no longer licensed for use in this age group).
  • Elderly people.
  • Severely decreased kidney function.
  • Severely decreased liver function.
  • Parkinson's disease.
  • People taking antipsychotic medicines or certain other medicines that act in the brain (see end of factsheet for more details).
  • People with a history of atopic allergies such as eczema, hayfever or asthma.
  • People with heart problems involving the conduction of the electrical signals in the heart, such as sick sinus syndrome, heart block or irregular heartbeats.
  • Hereditary blood disorders called porphyrias.

Not to be used in

  • People with bleeding in the stomach or intestines (gastrointestinal haemorrhage).
  • People with an abnormal hole in the stomach or intestines (gastrointestinal perforation).
  • People with a blockage of the stomach or intestines (gastrointestinal obstruction).
  • The first three to four days following surgery on the gut (eg pyloroplasty or gut anastomosis).
  • People with a tumour of the adrenal gland (phaeochromocytoma).
  • Epilepsy.
  • Maxolon tablets contain lactose and should not be taken by people with rare hereditary problems of galactose intolerance, the Lapp lactose deficiency of glucose-galactose malabsorption.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine is not known to be harmful when used by pregnant women, but as with all medicines it should be used with caution during pregnancy, and only when considered essential, particularly during the first trimester. Seek medical advice from your doctor.
  • This medicine passes into breast milk. It is not recommended for women who are breastfeeding. Seek further medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

  • Abnormal movements of the hands, legs, face, neck and tongue, eg tremor, twitching, rigidity (extrapyramidal effects). Tell your doctor if you notice any symptoms like this.
  • High blood prolactin (milk producing hormone) level (hyperprolactinaemia). Sometimes this can lead to symptoms such as breast enlargement, production of milk and stopping of menstrual periods.
  • Restlessness.
  • Anxiety.
  • Confusion.
  • Drowsiness.
  • Dizziness.
  • Diarrhoea.
  • Skin reactions such as rash and itch.
  • Swelling due to fluid retention (oedema).
  • Depression.
  • Visual disturbances.
  • Shortness of breath.
  • Rhythmical involuntary movement of the tongue, face, mouth and jaw, which may sometimes be accompanied by involuntary movements of the arms and legs (tardive dyskinesia).
  • High temperature combined with falling levels of consciousness, paleness, sweating and a fast heart beat (neuroleptic malignant syndrome). Requires stopping the medicine and immediate medical treatment.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

Due to its action on the gut, metoclopramide may affect the absorption of various other medicines that are taken by mouth. A positive application of this is for relieving migraine, where metoclopramide speeds the absorption into the bloodstream of painkillers such as paracetamol and aspirin.

Metoclopramide may decrease the blood level of atovaquone.

Metoclopramide may increase the blood level of ciclosporin.

Metoclopramide may increase the drowsiness and sedation that are side effects of opioid painkillers such as morphine.

Metoclopramide may oppose the effect of medicines for Parkinson's disease that work by stimulating dopamine receptors in the brain, for example ropinirole, pergolide, rotigotine, bromocriptine.

Metoclopramide may oppose the prolactin lowering effect of bromocriptine or cabergoline.

There may be an increased risk of side effects known as extrapyramidal effects if metoclopramide is taken with tetrabenazine or with antipsychotic medicines, eg chlorpromazine. Extrapyramidal side effects involve abnormal movements of the hands, legs, face and tongue, for example tremor or twitching.

There may be an increased risk of a side effect called the serotonin syndrome if metoclopramide is taken in combination with the following medicines:

  • selective serotonin reuptake inhibitor antidepressants (SSRIs), such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine or sertraline
  • the herbal remedy St John's wort (Hypericum perforatum)
  • triptans for migraine, eg sumatriptan
  • tryptophan.

The following medicines may oppose the effect of metoclopramide on the gut:

  • antimuscarinic medicines for Parkinson's disease, eg procyclidine, trihexyphenidyl, orphenadrine
  • antimuscarinic medicines for urinary incontinence, eg oxybutynin, flavoxate, tolterodine, propiverine, trospium
  • antispasmodic medicines, eg atropine, hyoscine
  • opioid painkillers, eg morphine, codeine.

Other medicines containing the same active ingredient

  • Maxolon high dose.
  • Maxolon injection.

Metoclopramide tablets, oral solution and injection are also available without a brand name, ie as the generic medicine.