Reglan (metoclopramide) is a popular, widely-used medication around the world. It is known by many other names and is also available as a generic. The medication must be used with care, however, particularly with respect to duration of use, to avoid serious side effects.

Reglan is used in both human and veterinary medicine to help with:

• Alleviating nausea and vomiting associated with migraines, chemotherapy, or pregnancy;
• Alleviating nausea and vomiting with no known cause;
• Improving gastroparesis (poor stomach emptying);
• Treating gastroesophageal reflux disease (GERD).

The medication is often effective on its own, or it can be mixed with other medications for greater effect.

Reglan should not be used for more than 12 consecutive weeks without explicit doctor approval, which is rare.

There is no evidence that Reglan is harmful to unborn babies if taken at any stage of pregnancy. It is excreted in breast milk, and again there is no evidence of harm, though this aspect is not as well-studied as in pregnancy and there may be some level of risk if used while breastfeeding.

Instructions for Use

While Reglan is available in several formulations, including injections and oral solutions, tablets are the most commonly used. Dosage and duration of treatment can be quite variable. Tablets are often, but not always, taken about 30 minutes prior to a meal.

To manage GERD or to improve gastroparesis, treatment is typically:

• Take 10 to 15 mg four times per day, 30 minutes prior to a meal and before bed (total 40 to 60 mg per day).
• If symptoms occur only at certain times or following certain situations, 10 to 20 mg may be taken prior to the time or provoking situation instead of four times per day.
• Do not exceed 20 mg in a single dose.
• Treatment typically continues for 2 to 8 weeks.
• Do not exceed 12 weeks of treatment without explicit doctor approval.

In other applications treatment is usually more as-needed. In treating migraine or other nausea and vomiting causes---such as from chemotherapy, pregnancy, or something else---treatment is often:

• Take 10 to 15 mg at the earliest symptoms.
• Do not exceed 20 mg in a single dose.
• Doctor instructions are variable in these cases and may deviate from the above. Always follow doctor instructions.

In the latter cases, with as-needed use, duration of treatment is less clear. If use is just a couple of times a month it can probably continue indefinitely; if use is daily, even just once per day, it should not exceed 12 weeks. If use is two or three times a week, duration should be discussed with a doctor.

Most patients experience relief with the first dose, though in treating more chronic problems---like GERD or gastroparesis---it may take 1 to 3 weeks before significant benefit is seen.

It is clear that Reglan treats symptoms; it is less clear if it promotes healing in chronic conditions. Results are mixed, and those taking Reglan to treat GERD will likely need to attend regular checkups to monitor healing. Healing will take place naturally to some extent when the condition is managed.

Important Side Effects

The biggest concern with Reglan use is the development of extrapyramidal symptoms, most notably tardive dyskinesia, a condition in which involuntary, repetitive body movements develop. It is not always reversible when treatment ends, though it can often be mitigated to some extent.

The majority of patients who develop extrapyramidal symptoms are under 20 years old and take Reglan at high doses for more than 3 consecutive months. Even among those under 20 who take high doses of Reglan for longer than 3 months, developing extrapyramidal symptoms is rare, and the condition being irreversible is even more rare; however, because it is a serious affliction that can have a significant impact on a patient's life, caution is warranted.

Symptoms of extrapyramidal symptoms to be alert for include:

• Involuntary movements of the torso, limbs, or fingers;
• Lip puckering, pursing, or smacking;
• Grimacing;
• Excessive eye blinking;
• Vision changes/problems;
• Restlessness;
• Muscle rigidity.

If the above are experienced, immediately stop taking Reglan and seek medical attention.

Depression is another side effect of Reglan; again rare, but with potentially serious consequences. Patients with a history of depression, currently taking antidepressants, and individuals taking antipsychotics should be sure the prescribing doctor is aware. These patients may require extra monitoring.