Friday October 30, 2009
Reglan


Q: Reglan (Metoclopramide) is a very commonly use drug in ICU. Does it get removed via CVVHD ?


A: NO !

(Reglan) Metoclopramide is excreted principally through the kidneys. In patients with creatinine clearance below 40 mL/min, dose should be curtailed at approximately one-half the recommended dosage. Dialysis removes relatively little Metoclopramide. Similarly, continuous ambulatory peritoneal dialysis does not remove significant amounts of drug.

Cumulative doses with prolong ang higher dose may manifest as tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements. Elderly patients are likely to develop the syndrome. 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.




recommended article

1. Drug Dosing in Critically Ill Patients with Renal Failure: A Pharmacokinetic Approach - Journal of Intensive Care Medicine, Volume 15 Issue 6 Page 273-313, November/December 2000