Taking Plasil may cause you to develop a muscle problem called tardive dyskinesia. If you develop tardive dyskinesia, you will move your muscles, especially the muscles in your face in unusual ways. You will not be able to control or stop these movements. Tardive dyskinesia may not go away even after you stop taking Plasil. The longer you take Plasil, the greater the risk that you will develop tardive dyskinesia. Therefore, your doctor will probably tell you not to take Plasil for longer than 12 weeks. The risk that you will develop tardive dyskinesia is also greater if you are taking medications for mental illness, if you have diabetes, or if you are elderly, especially if you are a woman. Call your doctor immediately if you develop any uncontrollable body movements, especially lip smacking, mouth puckering, chewing, frowning, scowling, sticking out your tongue, blinking, eye movements, or shaking arms or legs.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with Plasil and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.
Talk to your doctor about the risks of taking Plasil.
Other Special Populations
Patients with NADH-cytochrome b5 reductase deficiency are at an increased risk of developing methemoglobinemia and/or sulfhemoglobinemia when Plasil is administered. In patients with G6PD deficiency who experience Plasil- induced methemoglobinemia, methylene blue treatment is not recommended (see OVERDOSE).
Before taking Plasil
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking Plasil it is important that your doctor or pharmacist knows:
Where can I get more information:
Your pharmacist has additional information about Plasil written for health professionals that you may read.
Call your veterinarian for medical advice about any side effects to your pet. You may report side effects to the FDA at 1-800-FDA-1088.
What other drugs will affect Plasil:
Before giving Plasil, tell your veterinarian if your pet is being given an MAOI such as selegiline or Anipryl (within the last 14 days), digoxin, cyclosporine, tetracycline, insulin, a narcotic pain reliever or anticholinergic or antispasmodic medications such as Bentyl (dicyclomine). Also tell your veterinarian of any other medications you are giving that may cause drowsiness such as pain relievers, anxiety medications, muscle relaxants or any other prescription or over the counter medications.
Metoclopram > Plasil , a procainamide derivative and a benzamide prokinetic agent, is the most commonly used D 2 receptor antagonist for antiemetic prophylaxis, primarily for PONV and chemotherapy associated with low emetogenic risk. It is assumed that both the central D2 receptor antagonist activity at the CTZ and vomiting center and peripheral activity in the GI tract contribute to the antiemetic effect. Plasil acts upon peripheral D2, muscarinic, and 5-HT4 receptors to induce prokinetic activity. Opioids can cause delayed gastric emptying, but Plasil enhances gastric motility and increases intestinal peristalsis, which reduces reflux of stomach contents and the urge to vomit. Because of its short half-life of 5 to 6 hours, Plasil is likely to have greatest efficacy if administered at the end of surgery.
Plasil was first prescribed for CINV in high doses (e.g., 200 mg every 4-6 hours), which cause extrapyramidal symptoms in more than 10% of patients. 29 To reduce the incidence of adverse effects, Plasil is available in vials of just 10 mg. However, extensive studies and a meta-analysis have demonstrated that 10 mg Plasil has no clinically relevant antiemetic effect. 30 In fact, a large and well-designed dose-response study in more than 3000 patients demonstrated that doses of 25 and 50 mg metoclopram >Figure 29-5, C ). 31
Like haloperidol, Plasil is metabolized primarily by CYP 2D6. Although several studies have shown CYP 2D6 polymorphisms that result in reduced CYP 2D6 activity are associated with a higher incidence of Plasil adverse effects, no studies have investigated yet whether CYP 2D6 polymorphisms influence the antiemetic efficacy of the drug. Given that nearly 25% of Plasil is excreted unchanged, however, the effect of CYP 2D6 polymorphisms might be relatively small, at least in patients with normal renal function.
Like other D2 receptor antagonists, Plasil is associated with severe cardiac adverse effects. 32 High doses are associated with a high incidence of extrapyramidal symptoms, but lower doses (25-50 mg) are associated with less than 1% incidence of dyskinetic and/or extrapyramidal symptoms. 31 It is important to note that the FDA issued a black box warning for Plasil, given the high risk of developing tardive dyskinesia if Plasil use extends beyond 12 weeks. However, this concern likely does not apply to a short-term course of Plasil in the perioperative setting.
Other D2 receptor antagonists such as alizapride, perphenazine, and prochlorperazine might be as effective as other commonly used antiemetics, but they are rarely used, and their side-effect profiles are unclear compared with that of other antiemetics. 22
Plasil should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation.
Plasil is contraindicated in patients with pheochromocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumor. Such hypertensive crises may be controlled by phentolamine.
Plasil is contraindicated in patients with known sensitivity or intolerance to the drug. Plasil should not be used in epileptics or patients receiving other drugs which are likely to cause extrapyramidal reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased.
In general, the incidence of adverse reactions correlates with the dose and duration of Plasil administration. The following reactions have been reported, although in most instances, data do not permit an estimate of frequency:
Michael Stewart, Reviewed by Sid Dajani | Last edited 28 Nov 2019 | Certified by The Information Standard
Plasil is used to help prevent you from feeling sick (nausea) or being sick (vomiting).
Plasil may make you feel drowsy. If this happens do not drive and do not use tools or machines until you feel well again.
If you experience any unusual movements of your body, head, face or eyes, speak with your doctor or pharmacist straightaway.
To reduce the chances of you experiencing these side-effects, Plasil should not normally be taken for more than five days in a row.
COMMON BRAND(S): Reglan
GENERIC NAME(S): Plasil Hcl
OTHER NAME(S): Plasil Hcl ODTPlasil Hcl Tablet
This medication may cause a serious movement disorder called tardive dyskinesia. In some cases, this condition may be permanent. The risk of tardive dyskinesia is increased with the longer use of the medication and the more medication that you take. The risk is also increased in older adults (especially women) and in people with diabetes. Do not use Plasil for longer than 12 weeks. Talk to your doctor about the risks and benefits of this medication.
Tell your doctor right away if you develop any unusual uncontrolled movements (especially of the face, mouth, tongue, arms or legs). There is no treatment for tardive dyskinesia, but in some cases the symptoms may lessen or stop once Plasil is stopped.
This medication is used to treat certain conditions of the stomach and intestines. Plasil is used as a short-term treatment (4 to 12 weeks) for persistent heartburn when the usual medicines do not work well enough. It is used mostly for heartburn that occurs after a meal or during the daytime. Treating persistent heartburn can decrease the damage done by stomach acid to the swallowing tube (esophagus) and help healing.
Plasil is also used in diabetic patients who have poor emptying of their stomachs (gastroparesis). Treating gastroparesis can decrease symptoms of nausea, vomiting, and stomach/abdominal fullness. Plasil works by blocking a natural substance (dopamine). It speeds up stomach emptying and movement of the upper intestines.
This drug is not recommended for use in children due to an increased risk of serious side effects (such as muscle spasms/uncontrolled muscle movements). Ask the doctor or pharmacist for details.