Generic Reglan (Metoclopramide)

Introduction

Reglan (metoclopramide) is a prescription medication used primarily to enhance gastrointestinal motility and to treat nausea and vomiting associated with certain medical conditions. The active ingredient, metoclopramide, is classified as a dopamine-D₂ receptor antagonist with pro-kinetic and anti-emetic properties. It is supplied as oral tablets of 10 mg strength and belongs to the group of gastro-prokinetic agents. In addition to its approved uses, clinicians sometimes employ metoclopramide for off-label indications such as gastroparesis in diabetic patients, although such applications are not formally sanctioned by regulatory agencies.

What is Reglan?

Reglan is a brand-name formulation containing the generic compound metoclopramide. Metoclopramide was first synthesized in the s and later approved by the U.S. Food and Drug Administration (FDA) for the treatment of nausea, vomiting, and gastric stasis. The drug is marketed under several brand names worldwide, including Reglan, Moteloc, and Micro-Kifen. Metoclopramide is the generic version of these branded products, offering a cost-effective alternative for patients who require pro-kinetic therapy.

How Reglan Works

Metoclopramide exerts its therapeutic effect through two principal mechanisms:

• Dopamine-D₂ receptor antagonism in the chemoreceptor trigger zone (CTZ) of the brain reduces the stimulus for nausea and vomiting.
• Serotonin-5-HT₄ receptor agonism in the gastrointestinal (GI) tract enhances acetylcholine release, which increases the frequency and amplitude of coordinated gastric contractions (pro-kinetic effect).

These actions promote faster gastric emptying and improve the coordinated movement of contents through the upper GI tract. Oral absorption is rapid, with peak plasma concentrations occurring within 1-2 hours. The drug’s elimination half-life is approximately 5-6 hours, and it is primarily excreted unchanged by the kidneys.

Conditions Treated with Reglan

• Nausea and vomiting associated with chemotherapy, radiotherapy, or postoperative status - Dopamine antagonism in the CTZ diminishes the emetic signal.
• Gastroparesis (delayed gastric emptying) in diabetic and non-diabetic patients - Enhanced gastric motility reduces symptoms such as early satiety, bloating, and abdominal discomfort.
• Reflux esophagitis and functional dyspeps - Accelerated gastric emptying lessens the volume of gastric contents available for reflux.

Each of these approved indications benefits from metoclopramide’s dual ability to suppress nausea while promoting GI motility, thereby addressing both the cause and the symptom.

Off-Label and Investigational Uses of Reglan

• Migraine-related nausea - Small clinical studies have reported reduction of nausea when metoclopramide is administered with standard migraine therapies.
• Peripheral neuropathic pain - Limited evidence suggests dopamine antagonism may alleviate certain neuropathic pain syndromes, but safety data are insufficient for routine use.
• Adjunctive treatment for acute vertigo - Case series indicate modest benefit in reducing vertigo-associated nausea, though formal trials are lacking.

These off-label applications have not received formal approval from the FDA, European Medicines Agency (EMA), or other major regulators. Patients should discuss any consideration of off-label use with a qualified healthcare professional, as the balance of efficacy and risk may differ from approved indications.

Is Reglan the Right Medication for You?

Reglan is most appropriate for adults who:

• Experience frequent nausea or vomiting linked to chemotherapy, surgery, or radiotherapy.
• Have documented gastroparesis with objective evidence of delayed gastric emptying (e.g., scintigraphy).
• Require short-term enhancement of gastric motility to facilitate oral medication absorption or feeding.

Contraindications include:

• Known hypersensitivity to metoclopramide or any formulation component.
• History of extrapyramidal reactions or tardive dyskinesia.
• Presence of a mechanical gastrointestinal obstruction, perforation, or severe ulcer disease.

Patients with chronic renal impairment, seizure disorders, or endocrine disorders (e.g., pheochromocytoma) should use metoclopramide only after thorough clinical evaluation.

Risks, Side Effects, and Interactions

Common

• Drowsiness, fatigue
• Dry mouth, metallic taste
• Diarrhea or abdominal cramping

Rare

• Elevated prolactin levels leading to galactorrhea or menstrual irregularities
• Extrapyramidal symptoms (e.g., acute dystonia, oculogyric crisis)
• Hypotension or orthostatic dizziness

Serious

• Tardive dyskinesia - a potentially irreversible movement disorder that may develop after prolonged use (>12 weeks).
• Neuroleptic malignant syndrome - characterized by hyperthermia, muscle rigidity, and autonomic instability.
• Severe allergic reactions (anaphylaxis, angioedema).

Drug-Drug Interactions

• CYP2D6 substrates (e.g., codeine, tramadol) - metoclopramide may reduce their analgesic effect.
• Anticholinergic agents - additive anticholinergic load may increase constipation or urinary retention.
• Serotonergic drugs (e.g., SSRIs, MAO inhibitors) - risk of serotonin syndrome when combined with metoclopramide’s 5-HT₄ agonist activity.

Drug-Food Interactions

• Alcohol may potentiate central nervous system depression and dizziness.
• High-fat meals can delay gastric emptying, potentially diminishing the intended pro-kinetic effect; however, the clinical impact is modest.

Use: Dosing, Missed Dose, Overdose

• Typical adult dosing for nausea/vomiting: 10 mg orally, 30 minutes before anticipated emetogenic stimulus; may be repeated every 6-8 hours as needed, not exceeding 30 mg per day.
• Gastroparesis: 10 mg orally before each meal and at bedtime, usually 3-4 times daily; total daily dose should not exceed 40 mg.
• Maximum duration: For most indications, use should be limited to 12 weeks to reduce the risk of tardive dyskinesia.

Missed dose: Take the missed tablet as soon as remembered unless the next scheduled dose is within 2 hours; in that case, skip the missed dose and continue the regular schedule. Do not double the dose.

Overdose: Symptoms may include severe drowsiness, extrapyramidal reactions, and cardiac arrhythmias. Seek emergency medical assistance immediately; supportive care and activated charcoal are typical interventions.

Practical precautions:

• Take tablets with a full glass of water; food does not markedly affect absorption but may reduce gastric irritation.
• Avoid operating heavy machinery or driving until you know how metoclopramide affects you.
• Refrain from consuming large quantities of alcohol while on therapy.

FAQ

• What should I do if I experience muscle spasms while taking Reglan? Metoclopramide can cause acute dystonic reactions, especially in younger adults. If you notice involuntary muscle contractions, contact a healthcare professional promptly; anticholinergic medication may be required to relieve symptoms.

• Can Reglan be used during pregnancy? Metoclopramide is classified as pregnancy category B in the United States, indicating no evidence of fetal risk in animal studies but limited human data. Its use should be limited to situations where the potential benefit justifies any potential risk to the fetus.

• Is it safe to combine Reglan with herbal supplements such as St. John’s wort? St. John’s wort induces CYP3A4 and may alter metoclopramide metabolism, potentially reducing its effectiveness. Discuss any supplement use with a qualified professional before starting metoclopramide.

• How should Reglan be stored in hot climates? Store tablets at controlled room temperature (20-25 °C/68-77 °F). In environments exceeding 30 °C (86 °F), keep the medication in a cool, dry place away from direct sunlight, such as a locked cabinet or insulated container.

• Will metoclopramide show up on a standard drug test? Standard employment drug screens (e.g., urine immunoassays for amphetamines, THC, opiates) do not target metoclopramide, so routine tests usually return negative. Specialized assays would be required to detect it.

• Can I travel internationally with Reglan tablets? Yes, but keep the medication in its original labeled container, carry a copy of the prescription or a physician’s letter, and verify the import regulations of the destination country, as some nations restrict certain psychotropic agents.

• Is there an equivalent liquid formulation for patients who cannot swallow pills? Metoclopramide is also available as an oral solution (5 mg/mL) and injectable forms. The oral solution can be useful for patients with dysphagia; dosage adjustments should follow the same milligram equivalents as the tablet.

• What inactive ingredients are present in the 10 mg Reglan tablet? Typical excipients include lactose monohydrate, microcrystalline cellulose, magnesium stearate, and a film coating of hypromellose. Patients with lactose intolerance or hypersensitivity to these agents should review the full ingredient list.

• How does metoclopramide differ from other anti-emetics like ondansetron? Ondansetron primarily blocks serotonin-5-HT₃ receptors in the CTZ and gastrointestinal tract, whereas metoclopramide blocks dopamine-D₂ receptors and stimulates 5-HT₄ receptors. Metoclopramide thus combines anti-emetic and pro-kinetic actions, making it suitable for conditions where delayed gastric emptying contributes to nausea.

• Can long-term use of Reglan affect hormone levels? Metoclopramide can raise prolactin levels by antagonizing dopamine’s inhibitory effect on pituitary lactotrophs. Chronic elevation may lead to galactorrhea, menstrual disturbances, or decreased libido. Monitoring is advised if therapy exceeds several weeks.

Glossary

Dopamine-D₂ receptor antagonist

A drug that blocks dopamine binding at D₂ receptors, reducing dopaminergic signaling in the brain’s emesis center.

Pro-kinetic agent

A medication that enhances the motility of the gastrointestinal tract, promoting faster gastric emptying.

Tardive dyskinesia

A potentially irreversible movement disorder characterized by repetitive, involuntary facial and limb movements, often associated with prolonged dopamine antagonist use.

Buying Reglan from Our Online pharmacy

Metoclopramide tablets are readily available through our online pharmacy. By sourcing the generic version, you benefit from a price that is close to manufacturer cost while receiving medication that meets stringent quality standards. All products are obtained from licensed, vetted suppliers and undergo independent verification to ensure authenticity.

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Choosing our online pharmacy means you receive a reliable, cost-effective solution without compromising safety or confidentiality.

Disclaimer

The information presented about Reglan is intended for general educational purposes and does not substitute professional medical advice. Treatment decisions, including any off-label applications, should be made under the supervision of a qualified health-care provider. Readers are assumed to be responsible adults capable of making informed health choices. Our online pharmacy offers access to Reglan for individuals who may encounter limited availability through conventional pharmacies or who seek affordable generic alternatives. Always consult a qualified professional before initiating, modifying, or discontinuing any medication.