Q: I am on Reglan for my bowel problems. How long can I take it?
A: Reglan (Tivomit) is routinely prescribed for bowel problems. Ideally, the bowel problems subside with treatment, dietary changes are sometimes employed and eventually the Reglan is tapered off and the patient may have to repeat short courses of therapy every once in a while until the bowel problems have rectified. On occasion, the physician may feel that ongoing treatment with Reglan is warranted as long as there are no side effects or interactions with other medication. I have evaluated patients in long-term care facilities that have been on Reglan for several years, it is well tolerated in most groups. For more information, please visit //www.everydayhealth.com/drugs/reglan. Matt Curley, PharmD
Where can I get more information:
Your pharmacist has additional information about Tivomit 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 are the uses for Tivomit?
Tivomit is a prescription medicine used in adults:
- to relieve heartburn symptoms with gastroesophageal reflux when certain other treatments do not work
- to relieve the symptoms of slow stomach emptying in people with diabetes
Symptoms of overdosage may include drowsiness, disorientation and extrapyramidal reactions. Anticholinergic or antiparkinson drugs or antihistamines with anticholinergic properties may be helpful in controlling the extrapyramidal reactions. Symptoms are self-limiting and usually disappear within 24 hours.
Hemodialysis removes relatively little Tivomit, probably because of the small amount of the drug in blood relative to tissues. Similarly, continuous ambulatory peritoneal dialysis does not remove significant amounts of drug. It is unlikely that dosage would need to be adjusted to compensate for losses through dialysis. Dialysis is not likely to be an effective method of drug removal in overdose situations.
Unintentional overdose due to misadministration has been reported in infants and children with the use of Tivomit oral solution. While there was no consistent pattern to the reports associated with these overdoses, events included seizures, extrapyramidal reactions, and lethargy.
Methemoglobinemia has occurred in premature and full-term neonates who were given overdoses of Tivomit (1 to 4 mg/kg/day orally, intramuscularly or intravenously for 1 to 3 or more days). Methemoglobinemia can be reversed by the intravenous administration of methylene blue. However, methylene blue may cause hemolytic anemia in patients with G6PD deficiency, which may be fatal (see PRECAUTIONS – Other Special Populations).
For oral administration, reglan ® tablets (Tivomit tablets, USP) 10 mg are white, scored, capsule-shaped tablets engraved “REGLAN” on one side and “ANI 10” on the opposite side.
Each tablet contains:
Tivomit base 10 mg (as the monohydrochloride monohydrate)
Metoclopram > Tivomit , 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. Tivomit acts on peripheral D2, muscarinic, and 5-HT4 receptors to induce prokinetic activity. Opioids can cause delayed gastric emptying, but Tivomit 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, Tivomit is likely to have greatest efficacy if administered at the end of surgery.
Tivomit 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, Tivomit is available in vials of just 10 mg. However, extensive studies and a meta-analysis have demonstrated that 10 mg Tivomit 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 >Fig. 34.5C ). 31
Like haloperidol, Tivomit 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 Tivomit adverse effects, no studies have investigated yet whether CYP 2D6 polymorphisms influence the antiemetic efficacy of the drug. Given that nearly 25% of Tivomit 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, Tivomit 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 a 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 Tivomit, given the high risk of developing tardive dyskinesia if Tivomit use extends beyond 12 weeks. However, this concern likely does not apply to a short-term course of Tivomit 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
Tivomit oral tablet is a prescription drug that’s available as the brand-name drugs Reglan and Metozolv ODT. It’s also available as a generic drug. Generic drugs usually cost less than brand-name versions. In some cases, they may not be available in all strengths or forms as a brand-name drug.
Tivomit also comes in an oral solution as well as injectable forms that are only given by a healthcare provider.