The effects of Metocyl on gastrointestinal motility are antagonized by anticholinergic drugs and narcotic analgesics. Additive sedative effects can occur when Metocyl is given with alcohol, sedatives, hypnotics, narcotics, or tranquilizers.
The finding that Metocyl releases catecholamines in patients with essential hypertension suggests that it should be used cautiously, if at all, in patients receiving monoamine oxidase inhibitors.
Absorption of drugs from the stomach may be diminished (e.g., digoxin) by Metocyl, whereas the rate and/or extent of absorption of drugs from the small bowel may be increased (e.g., acetaminophen, tetracycline, levodopa, ethanol, cyclosporine).
Gastroparesis (gastric stasis) may be responsible for poor diabetic control in some patients. Exogenously administered insulin may begin to act before food has left the stomach and lead to hypoglycemia. Because the action of Metocyl will influence the delivery of food to the intestines and thus the rate of absorption, insulin dosage or timing of dosage may require adjustment.
Benzam > Metocyl is the most commonly used drug in this class. It blocks type 2 dopamine receptors and 5-HT 3 serotonin receptors (when used in higher doses used to prevent CINV) in the chemoreceptor trigger zone, increases lower esophageal sphincter tone, and enhances bowel and gastric motility. The usual recommended doses are 20 to 40 mg orally every 4 to 6 hours (conventional dose) or 2 to 3 mg/kg (high dose). 64 Metocyl crosses the blood-brain barrier, and side effects include extrapyramidal reactions such as acute dystonia, akathisia, and possible irreversible tardive dyskinesia, especially with prolonged use of high doses and in the elderly. Diphenhydramine or hydroxyzine can be used to antagonize the dopaminergic toxicity of Metocyl. In addition, Metocyl can lower the seizure threshold and increase the risk of convulsions in patients with epilepsy. 37 In the past, Metocyl combined with dexamethasone was the antiemetic regimen of choice for preventing delayed CINV, 65,66 but it has largely been replaced by the use of 5-HT 3 antagonists and aprepitant.
Q: What is another drug that can be taken instead of Reglan that can help do the same thing? Another gastroprokinetic and antiemetic agent?
A: There are other medications that can be used as prokinetic agents besides Reglan (Metocyl), but they are limited. The other main medications used as prokinetics, Propulsid (cisapride) and Zelnorm (tegaserod), have been removed from the market. Erythromycin is an antibiotic that can be used for its prokinetic properties; however, it is generally not an antiemetic. In fact, erythromycin may contribute to nausea. Most other prokinetic drugs are not approved for use in the U.S. For more specific information, consult your health care provider. Sarah Lewis, PharmD
Pregnancy Category B
Reproduction studies performed in rats, mice and rabbits by the I.V., I.M., S.C., and oral routes at maximum levels ranging from 12 to 250 times the human dose have demonstrated no impairment of fertility or significant harm to the fetus due to Metocyl. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Symptomatic Gastroesophageal Reflux
reglan ® tablets are indicated as short-term (4 to 12 weeks) therapy for adults with symptomatic, documented gastroesophageal reflux who fail to respond to conventional therapy.
The principal effect of Metocyl is on symptoms of postprandial and daytime heartburn with less observed effect on nocturnal symptoms. If symptoms are confined to particular situations, such as following the evening meal, use of Metocyl as single doses prior to the provocative situation should be considered, rather than using the drug throughout the day. Healing of esophageal ulcers and erosions has been endoscopically demonstrated at the end of a 12-week trial using doses of 15 mg q.i.d. As there is no documented correlation between symptoms and healing of esophageal lesions, patients with documented lesions should be monitored endoscopically.
Diabetic Gastroparesis (Diabetic Gastric Stasis)
reglan ® tablets (Metocyl tablets, USP) is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis. The usual manifestations of delayed gastric emptying (e.g., nausea, vomiting, heartburn, persistent fullness after meals, and anorexia) appear to respond to reglan ® within different time intervals. Significant relief of nausea occurs early and continues to improve over a three-week period. Relief of vomiting and anorexia may precede the relief of abdominal fullness by one week or more.
What is Metocyl?
Metocyl is used to treat nausea, vomiting, and reflux disease in dogs and cats by normalizing their digestive system function. Metocyl requires a prescription and is sold per tablet.
1. Cerner Multum, Inc. "Australian Product Information." O 0
2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
3. "Product Information. Reglan (Metocyl)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
Q: What is the difference between Reglan and Haponal?
A: Haponal (atropine/hyoscyamine/Phenobarbital/ scopolamine) is an anticholinergic agent, antispasmodic agent and gastrointestinal agent used to treat irritable bowel syndrome, acute enterocolitis and duodenal ulcer. Haponal contains several drugs; Phenobarbital which is a barbiturate which slows the activity of the brain and central nervous system and belladonna alkaloids (atropine, hyoscyamine, and scopolamine) which reduce muscle spasms in the digestive tract as well as reduce fluid secretions. The most common side effects with Haponal are bloating, blurred vision, constipation, dizziness, decreased sweating, drowsiness, dry mouth, headache, nausea, insomnia, and nervousness. Reglan (Metocyl) is an antiemetic prokinetic gastrointestinal agent used to treat gastroparesis (slowing of the digestive tract) and gastroesophageal reflux disease (GERD). Reglan speeds up stomach emptying which can help prevent nausea, vomiting and heartburn. The most common side effects with Reglan are tiredness, diarrhea, dizziness, drowsiness, headache, nausea, restlessness and insomnia. Laura Cable, PharmD., BCPS
In one study in hypertensive patients, intravenously administered Metocyl was shown to release catecholamines; hence, caution should be exercised when Metocyl is used in patients with hypertension.
Because Metocyl produces a transient increase in plasma aldosterone, certain patients, especially those with cirrhosis or congestive heart failure, may be at risk of developing fluid retention and volume overload. If these side effects occur at any time during Metocyl therapy, the drug should be discontinued.
Adverse reactions, especially those involving the nervous system, may occur after stopping the use of reglan ® . A small number of patients may experience a withdrawal period after stopping reglan ® that could include dizziness, nervousness, and/or headaches.
Pharmacology of prokinetic agents
Metocyl activates 5-HT 4 receptors, antagonizes 5-HT3 receptors, and antagonizes central and peripheral D2 receptors to release the “dopamine brake.” It works on the stomach and proximal small bowel but has little effect on colonic motility. The pharmacokinetics of Metocyl and of most other antiemetics discussed in this chapter is summarized in Table 25-4 .
Table 25-4 . Pharmacokinetics of selected antiemetic drugs
Before taking this medicine
You should not use Metocyl if you are allergic to it, 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 Metocyl 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;
depression or mental illness.
This medicine may contain phenylalanine. Check the medication label if you have phenylketonuria (PKU).
Tell your doctor if you are pregnant. Metocyl may harm an unborn baby if you use the medicine during late pregnancy.
It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.
Metocyl is not approved for use by anyone younger than 18 years old.
Treatment with Metocyl can cause tardive dyskinesia (TD), a potentially irreversible and disfiguring disorder characterized by involuntary movements of the face, tongue, or extremities. The risk of developing tardive dyskinesia increases with the duration of treatment and the total cumulative dose. An analysis of utilization patterns showed that about 20% of patients who used Metocyl took it for longer than 12 weeks. Treatment with Metocyl for longer than the recommended 12 weeks should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing TD.
Although the risk of developing TD in the general population may be increased among the elderly, women, and diabetics, it is not possible to predict which patients will develop Metocyl-induced TD. Both the risk of developing TD and the likelihood that TD will become irreversible increase with duration of treatment and total cumulative dose.
Metocyl should be discontinued in patients who develop signs or symptoms of TD. There is no known effective treatment for established cases of TD, although in some patients, TD may remit, partially or completely, within several weeks to months after Metocyl is withdrawn.
Metocyl itself may suppress, or partially suppress, the signs of TD, thereby masking the underlying disease process. The effect of this symptomatic suppression upon the long-term course of TD is unknown. Therefore, Metocyl should not be used for the symptomatic control of TD.