Metoclopramide - Is it under utilized?

[irme]

Hi there,

I am a student paramedic in my second year of my degree and am aloud to give maxalon under supervision. Obviously before i do this i want a firm understanding of the drug. On my ride alongs' i have noted many paramedics are cautious with this drug.

- They do not give it to the patient if the pt states they have not been able to have a bowel motion recently

- They do not give it for patients with diarrhea

Upon reading my guidelines *note: not protocols!* they state maxalon is contra-indicated in diagnosed bowel obstruction... So are these paramedics right to be withholding maxalon? I understand the rational through not giving the drug to someone with diarrhea - your only going to push it through faster.. but so fast they lose control of there bowels??

Just a newbie after some answers!

Regards

[Ridryder 911]

Actually, I had to look this one up. I have never heard of the medication or seen it used in ER or prehospital setting, and I see why. It is apparently a popular antiemetic medication associated with those receiving chemo treatments, but has a high incidence of decreasing motility and causing bowel obstructions.

I am sure the medics want to be sure that motility is good before potentially causing bowel obstructions, and bowel infarction. The point of not giving it to patients with diarrhea, I believe is not "pushing it through" faster, rather actually some of the clinical signs of bowel obstruction is leaking diarrhea around the obstruction. Therefore; potentially having a misdiagnosed B.O. The medication is excreted through the kidneys.

Personally, I am sure they rather use an antiemetic that has less side effects and more commonly used.

R/r 911

[ERDoc]

I use Reglan all the time with no problems. All meds are going to have their side effects. With Droperidol you have to worry about the THEORETIC cardiac issues and sedation. Phenergan is bad for reasons that have been discussed ad nauseum (pun intended) on other threads. Reglan is the least sedating (based on personal experience) and works pretty well.

[Just Plain Ruff]

Reglan or metoclopromide or maxalon is a great drug for nausea and who better to ask than the chemo patients who benefit from it so well.

I have used this medication over the years and it's a great anti-emetic. Just be cautious of the contraindications, the indications and the precautions as well as the patients response.

[Ridryder 911]

Oops !:oops: .. When I did look up, I did not recognize the name...that it was Reglan.... my bad.

Actually, I have used that several thousand times for nausea.. but, personally I do not see it as effective as other anti-emetics such as Compazazine, Phenergan.. but better than Zofran, if they have already started vomiting.

Doc, I have seen the "angered mentation" that I have read and heard about.. I thought, that it would be an isolated incidence, but have had two occurrences after adminstering Reglan .. Have you seen very many of those incidences?

R/r 911

[ERDoc]

Oops !:oops: .. When I did look up, I did not recognize the name...that it was Reglan.... my bad.

Actually, I have used that several thousand times for nausea.. but, personally I do not see it as effective as other anti-emetics such as Compazazine, Phenergan.. but better than Zofran, if they have already started vomiting.

Doc, I have seen the "angered mentation" that I have read and heard about.. I thought, that it would be an isolated incidence, but have had two occurrences after adminstering Reglan .. Have you seen very many of those incidences?

R/r 911

I have never seen the angered mentation, but you have probably been using it longer than I have (no offense). I have a personal bias against compazine as I have seen a family member develop torticolis from it. It is one of the most excrutiating things I Have ever seen. It's like watching some have an appendectomy without anesthesia.

[Dustdevil]

- They do not give it to the patient if the pt states they have not been able to have a bowel motion recently

It is important to quantify the term "recently." What do they call "recently?" For a lot of people, if they don't pinch one twice a day, they feel like they haven't had one "recently." Medically, we don't really give it a second thought until they've gone three days. And even then, we don't start thinking bowel obstruction until they are symptomatic and have failed to respond to laxative measures for a few days. It's something that is not diagnosed in the field, and the contraindication is for diagnosed obstructions, not the remote possibility of an obstruction.

As always, the benefits must outweigh the potential side effects, so each patient will be different. But in the great majority of cases, I'd say you could safely give it to most patients, even if they've gone three days without a BM. It's a personal call based upon your patient's presentation and the options you have available.

Are they really calling it Maxalon in that system? I thought Maxalon was strictly a PO form of metclopramide. I've never seen it as Maxalon.

[irme]

thanks for the info; forgot to say that might be a far south name for the same drug!

So in all of your opinions would you be giving this drug to an extremely uncomfortable nauseated patient with abdo pain who hasn’t had a bowel motion in 2 days?

Transport time at most where I am is an hour (and that is very much *at most*) and while I’m not saying give the drug for our benefit (less reaching!) and leave the consequences for the ER room doc to fix I am actually talking about making the patient more comfortable. Maxalon is the ONLY antiemetic that we carry so there are no other choices.

I just get the feeling that nausea is in many ways like pain; and a lot of the time goes unmanaged to the degree it could be, pre-hospitaly. I guess what I am really trying to say is it so dangerous as a drug that extreme caution should be taken, so much so to mean that any pt stating they have been unable to have a bowel motion in 24 hrs or state they have been “a bit constipated” should not be given this drug..?

Thanks for all info guys

[Scaramedic]

...if they don't pinch one twice a day...

Is that one of those technical terms I am going to learn in Nursing School?

Peace,

Marty

[irme]

Yes they really are!! http://www.medsafe.govt.nz/Profs/datasheet...bsyrinjsupp.htm

Thanks for your answer dust, it was my thoughts that it was being given too cautiously.. Guess i'll have to wait until i have a little more experience!