Maxeran

Generic Name

Metoclopramide

About Maxeran

Maxeran is an antiemetic medication and dopamine antagonist. As a gastrointestinal motility agent, it is most often prescribed to patients with gastroparesis, a condition that often occurs in patients with diabetes. The drug works by increasing the rate at which the stomach and intestines move during digestion. The medication may also be prescribed for gastric reflux disease and persistent heartburn. Additionally, Maxeran can be used to facilitate intubations and to stimulate gastric emptying for x-rays.

Maxeran and other metoclopramide drugs are also commonly prescribed to prevent nausea and vomiting in patients receiving anesthesia before surgery and in patients undergoing chemotherapy. In some cases, the medication is prescribed to patients with migraines, many of whom also suffer from nausea.

Metoclopramide and Tardive Dyskinesia

In 2004, a panel of experts from the U.S. Food and Drug Administration and other agencies published a study that showed patients taking metoclopramide are at risk of developing tardive dyskinesia (TD), a potentially irreversible disorder characterized by repetitive and involuntary body movements. Patients with tardive dyskinesia suffer from rapid movements of the extremities, excessive eye blinking, lip smacking, facial tics, tongue protrusion and other embarrassing movements.

Older women undergoing long-term treatment with metoclopramide are at particularly high risk of developing the condition. However, TD can affect others as well, including children. In some cases, the symptoms of tardive dyskinesia may cease when metoclopramide use is halted. In others, however, symptoms remain even after discontinuation of treatment with the drug.

Metoclopramide Today

While some have pushed for metoclopramide to be removed from the market, the medication continues to remain in use. However, in 2009, the FDA required that all metoclopramide medications carry a black box warning informing consumers and health care professionals about the potential risk of TD. The warning states that patients using metoclopramide for extended periods of time are at greater risk of developing the condition. Because of this risk, metoclopramide should not be used for more than 12 weeks, except in rare cases where the benefits of continued treatment outweigh the risks associated with long-term use of the medication.

Dosage

Maxeran dosages may vary among patients. Patients usually take the medication three to four times a day, approximately 30 minutes before meals. Patients usually take the medication in doses of 10 to 15 mg.

Missed doses should be taken as soon as remembered. However, if it is almost time for a patient's next dose, the missed dose should be skipped. Patients should not consume a double dose of Maxeran to compensate for a missed dose.

Contraindications

Maxeran should not be used in patients with the following conditions:

Seizures or epilepsy
Gastrointestinal bleeding or obstruction
Adrenal gland tumor

Additionally, patients with the following conditions should use metoclopramide with extreme caution and only after carefully weighing the risks and benefits of the medication:

Parkinson’s disease
Depression
Liver or kidney disease
Heart failure
High blood pressure
Asthma
Recent stomach surgery
Diabetes
Certain blood disorders
Cancer

No adequate studies have assessed the potential effects of Maxeran when used in pregnant women. Therefore, women who are pregnant or may become pregnant should not take Maxeran. Mothers who are nursing should also not take Maxeran, as the medication may harm a breast-fed child.

Drug Interactions

Many drugs can negatively interact with Maxeran. Those include, but are not limited to:

Monoamine oxidase (MAO) inhibitors and other antidepressants
Acetaminophen
Insulin
Digoxin
Tetracycline
Cyclosporine
Opioid-based pain relievers (e.g., morphine, hydrocodone, oxycodone)
Sleeping pills
Levodopa
Pergolide

Individuals who take Maxeran should limit their alcohol intake as the drug can increase the depressant effects of alcohol.

Maxeran may interact with other medications or substances that are not listed above. In order to avoid potentially hazardous interactions, patients should talk with their doctor about the use of any other medications, vitamins or supplements before beginning treatment with a new medication.

Side Effects

In addition to tardive dyskinesia, Maxeran may cause other side effects, some of which may be more serious than others. Additional potential side effects of the medication include:

High blood pressure
Irregular heartbeat
Agitation
Panic attacks
Restless leg syndrome
Drowsiness
Diarrhea
Restlessness
Headache
Insomnia
Menstrual changes
Nausea
Rash
Dry mouth

Sources

Mayo Clinic, http://www.mayoclinic.com/health/drug-information/DR600921
Journal of the American Pharmacists Association, http://japha.metapress.com/app/home/contribution.asp?referrer=parent&backto=issue,4,13;journal,36,47;linkingpublicationresults,1:120082,1
U.S. Food and Drug Administration, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm149533.htm
U.S. National Library of Medicine, http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684035.html

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