Ativan (lorazepam) belongs to a class of medications called benzodiazepines. It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain.

Ativan is used in adults and children at least 12 years old to treat anxiety disorders.

Ativan is also used to treat insomnia caused by anxiety or temporary situational stress.

Ativan is sometimes used to treat nausea and vomiting from cancer treatment and to control agitation caused by alcohol withdrawal.

Warnings

Ativan can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. These effects can be fatal.

MISUSE OF ATIVAN CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep this medicine where others cannot get to it.

Lorazepam may be habit-forming and should be used only by the person it was prescribed for. Ativan should never be shared with another person, especially someone who has a history of drug abuse or addiction.

Do not stop using Ativan without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Some withdrawal symptoms may last up to 12 months or longer.

Get medical help right away if you stop using Ativan and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide.

Do not use Ativan if you are pregnant. Lorazepam can cause birth defects or life-threatening withdrawal symptoms in a newborn.

You should not use this medicine if you have narrow-angle glaucoma, severe respiratory insufficiency, myasthenia gravis, or if you are allergic to Valium or a similar medicine.

Before taking this medicine

You should not use Ativan if you have:

• narrow-angle glaucoma; or
• a history of allergic reaction to any benzodiazepine (lorazepam, alprazolam, diazepam, Valium, Xanax, Versed, Klonopin, and others).

To make sure Ativan is safe for you, tell your doctor if you have ever had:

• asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;
• drug or alcohol addiction;
• depression, mental illness or psychosis, mood changes, or suicidal thoughts or actions;
• seizures;
• an allergy to aspirin or yellow food dye; or
• kidney or liver disease.

Tell your doctor if you are pregnant or plan to become pregnant. If you use Ativan during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of lorazepam on the baby.

You should not breastfeed.

If you do breastfeed, tell your doctor if you notice drowsiness, feeding problems, or slow weight gain in the nursing baby.

How should I take Ativan?

Take Ativan exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides or instruction sheets. Never use Ativan in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of this medicine.

Never share Ativan with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law.

Do not stop using Ativan without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use.

Store Ativan tablets tightly closed at room temperature, away from moisture and heat.

Keep your medicine in a place where no one can use it improperly.

Dosing information

Usual Adult Dose for Anxiety:

Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day
Maintenance dose: 1 to 2 mg orally 2 to 3 times a day

Uses:
-Management of anxiety disorders
-Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Adult Dose for Insomnia:

2 to 4 mg orally once a day at bedtime

Comments:
-The dosage should be increased gradually when needed to help avoid adverse effects.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Use: Management of insomnia due to anxiety of transient situational stress

Usual Geriatric Dose for Anxiety:

Older or debilitated patients:
-Initial dose: 1 to 2 mg orally per day, given in divided doses

-Management of anxiety disorders
-Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Pediatric Dose for Anxiety:

12 years or older:
-Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day
-Maintenance dose: 1 to 2 mg orally 2 to 3 times a day

-The daily dosage may vary from 1 to 10 mg/day.
-The dosage should be increased gradually when needed to help avoid adverse effects.
-When higher dosage is indicated, the evening dose should be increased before the daytime doses.
-Use of anxiolytic agents is typically not needed to treat anxiety/tension associated with the stress of everyday life.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Uses:
-Management of anxiety disorders
-Short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms

Usual Pediatric Dose for Insomnia:

12 years or older: 2 to 4 mg orally once a day at bedtime

Comments:
-For debilitated patients, an initial dosage of 1 to 2 mg/day in divided doses is recommended.
-The dosage should be increased gradually when needed to help avoid adverse effects.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of lorazepam can be fatal if you also drink alcohol or use other drugs that cause drowsiness or slow breathing.

Overdose symptoms may include severe drowsiness, confusion, slurred speech, feeling restless, muscle weakness, loss of balance or coordination, feeling light-headed, slow heartbeats, weak or shallow breathing, or coma.

What should I avoid while taking Ativan?

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how Ativan will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Ativan side effects

Get emergency medical help if you have signs of an allergic reaction to Ativan: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Lorazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Ativan may cause serious side effects. Call your doctor at once if you have:

• severe drowsiness;
• unusual changes in mood or behavior, being agitated or talkative;
• sudden restless feeling or excitement;
• seizures, depression, thinking problems, thoughts of suicide or hurting yourself;
• confusion, aggression, hallucinations;
• sleep problems (insomnia);
• vision changes; or
• dark urine, or jaundice (yellowing of the skin or eyes).

Drowsiness or dizziness may last longer in older adults. Use caution to avoid falling or accidental injury.

Common Ativan side effects may include:

• dizziness, sedation, drowsiness;
• weakness; or
• feeling unsteady.

You will need frequent blood tests to check your blood counts and liver function.

After you stop using Ativan, seek medical help right away if you have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, suicidal thoughts or actions.

Some withdrawal symptoms may last up to 12 months or longer after stopping Ativan suddenly. Tell your doctor if you have ongoing anxiety, depression, problems with memory or thinking, trouble sleeping, ringing in your ears, a burning or prickly feeling, or a crawling sensation under your skin.

What is lorazepam?

Lorazepam belongs to a class of medications called benzodiazepines. It is thought that benzodiazepines work by enhancing the activity of certain neurotransmitters in the brain.

Lorazepam is used in adults and children at least 12 years old to treat anxiety disorders.

Loreev XR extended-release  capsules are used to treat anxiety disorders in adults only.

Lorazepam is also used to treat insomnia caused by anxiety or temporary situational stress.

Lorazepam is sometimes used to treat nausea and vomiting from cancer treatment and to control agitation caused by alcohol withdrawal.

Warnings

Lorazepam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing. These effects can be fatal.

MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep this medicine where others cannot get to it.

Lorazepam may be habit-forming and should be used only by the person it was prescribed for. This medicine should never be shared with another person, especially someone who has a history of drug abuse or addiction.

Do not stop using lorazepam without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use. Some withdrawal symptoms may last up to 12 months or longer.

Get medical help right away if you stop using lorazepam and have symptoms such as: unusual muscle movements, being more active or talkative, sudden and severe changes in mood or behavior, confusion, hallucinations, seizures, or thoughts about suicide.

Do not use lorazepam if you are pregnant. This medicine can cause birth defects or life-threatening withdrawal symptoms in a newborn.

You should not use this medicine if you have narrow-angle glaucoma, severe respiratory insufficiency, myasthenia gravis, or if you are allergic to Valium or a similar medicine.

Before taking this medicine

You should not use lorazepam if you have:

• narrow-angle glaucoma; or
• a history of allergic reaction to any benzodiazepine (alprazolam, diazepam, Valium, Xanax, Versed, Klonopin, and others).

To make sure lorazepam is safe for you, tell your doctor if you have ever had:

• asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;
• drug or alcohol addiction;
• depression, mental illness or psychosis, mood changes, or suicidal thoughts or actions;
• seizures;
• an allergy to aspirin or yellow food dye; or
• kidney or liver disease.

Tell your doctor if you are pregnant or plan to become pregnant. If you use lorazepam during pregnancy, your baby could be born with life-threatening withdrawal symptoms, and may need medical treatment for several weeks.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of lorazepam on the baby.

You should not breastfeed.

If you do breastfeed, tell your doctor if you notice drowsiness, feeding problems, or slow weight gain in the nursing baby.

How should I take lorazepam?

Take lorazepam exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides or instruction sheets. Never use lorazepam in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more of lorazepam.

Never share this medicine with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law.

Measure the oral concentrate (liquid) with the supplied measuring device (not a kitchen spoon). Mix the liquid with water, juices, soda or soda-like beverages, or with semi-solid foods such as applesauce or puddings. Swallow this mixture right away.

Swallow the extended-release capsule whole and do not crush, chew, break, or open it.

If you cannot swallow a  capsule whole, open it and mix the medicine with applesauce. Swallow the mixture right away without chewing.

Do not stop using lorazepam without asking your doctor. You may have life-threatening withdrawal symptoms if you stop using the medicine suddenly after long-term use.

Store tightly closed at room temperature, away from moisture and heat.

Store the liquid form of this medicine in the refrigerator. Throw away any liquid not used within 90 days.

Keep your medicine in a place where no one can use it improperly.

Dosing information

Usual Adult Dose for Anxiety:

Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day
Maintenance dose: 1 to 2 mg orally 2 to 3 times a day.

Usual Adult Dose for Insomnia:

2 to 4 mg orally once a day at bedtime

Comments:
-The dosage should be increased gradually when needed to help avoid adverse effects.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Use: Management of insomnia due to anxiety of transient situational stress

Usual Geriatric Dose for Anxiety:

Older or debilitated patients:
-Initial dose: 1 to 2 mg orally per day, given in divided doses.

Usual Pediatric Dose for Anxiety:

12 years or older:
-Initial dose: 2 to 3 mg orally per day, given 2 to 3 times per day
-Maintenance dose: 1 to 2 mg orally 2 to 3 times a day

-The daily dosage may vary from 1 to 10 mg/day.
-The dosage should be increased gradually when needed to help avoid adverse effects.
-When higher dosage is indicated, the evening dose should be increased before the daytime doses.
-Use of anxiolytic agents is typically not needed to treat anxiety/tension associated with the stress of everyday life.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

Usual Pediatric Dose for Insomnia:

12 years or older: 2 to 4 mg orally once a day at bedtime

Comments:
-For debilitated patients, an initial dosage of 1 to 2 mg/day in divided doses is recommended.
-The dosage should be increased gradually when needed to help avoid adverse effects.
-Clinical studies have not evaluated this drug for efficacy in long-term treatment (e.g., greater than 4 months).

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . An overdose of lorazepam can be fatal if you also drink alcohol or use other drugs that cause drowsiness or slow breathing.

Overdose symptoms may include severe drowsiness, confusion, slurred speech, feeling restless, muscle weakness, loss of balance or coordination, feeling light-headed, slow heartbeats, weak or shallow breathing, or coma.

What should I avoid while taking lorazepam?

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how lorazepam will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Lorazepam side effects

Get emergency medical help if you have signs of an allergic reaction to lorazepam: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Lorazepam can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Lorazepam may cause serious side effects. Call your doctor at once if you have:

• severe drowsiness;
• unusual changes in mood or behavior, being agitated or talkative;
• sudden restless feeling or excitement;
• seizures, depression, thinking problems, thoughts of suicide or hurting yourself;
• confusion, aggression, hallucinations;
• sleep problems (insomnia);
• vision changes; or
• dark urine, or jaundice (yellowing of the skin or eyes).

Drowsiness or dizziness may last longer in older adults. Use caution to avoid falling or accidental injury.

Common lorazepam side effects may include:

• dizziness, sedation, drowsiness;
• weakness; or
• feeling unsteady.

What is metoclopramide?

Metoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines.

Metoclopramide oral (taken by mouth) is used for 4 to 12 weeks to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief.

Metoclopramide oral is also used to treat gastroparesis (slow stomach emptying) in people with diabetes, which can cause heartburn and stomach discomfort after meals.

Metoclopramide injection is used to treat severe diabetic gastroparesis. The injection is also used to prevent nausea and vomiting caused by chemotherapy or surgery, or to aid in certain medical procedures involving the stomach or intestines.

Warnings

Do not use this medicine if you’ve ever had muscle movement problems after using metoclopramide or similar medicines, or if you’ve had a movement disorder called tardive dyskinesia. You also should not use this medicine if you’ve had stomach or intestinal problems (a blockage, bleeding, or a hole or tear), epilepsy or other seizure disorder, or an adrenal gland tumor (pheochromocytoma).

NEVER USE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use can cause a serious movement disorder that may not be reversible. The longer you use metoclopramide, the more likely you are to develop this movement disorder. The risk of this side effect is higher in diabetics and older adults (especially women).

Before you take metoclopramide, tell your doctor if you have kidney or liver disease, congestive heart failure, high blood pressure, diabetes, Parkinson’s disease, or a history of depression.

Do not drink alcohol. It can increase some of the side effects of metoclopramide.

Stop using metoclopramide and call your doctor at once if you have tremors or uncontrolled muscle movements, fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing, depressed mood, thoughts of suicide or hurting yourself, hallucinations, anxiety, agitation, seizure, or jaundice (yellowing of your skin or eyes).

Before taking this medicine

You should not use metoclopramide if you are allergic to it, or if you have:

• tardive dyskinesia (a disorder of involuntary movements);
• stomach or intestinal problems such as a blockage, bleeding, or perforation (a hole or tear in your stomach or intestines);
• epilepsy or other seizure disorder;
• an adrenal gland tumor (pheochromocytoma); or
• if you’ve ever had muscle movement problems after using metoclopramide or similar medicines.

Tell your doctor if you have ever had:

• liver or kidney disease;
• problems with muscle movements;
• congestive heart failure or a heart rhythm disorder;
• high blood pressure;
• seizures;
• breast cancer;
• Parkinson’s disease;
• diabetes; or
• depression or mental illness.

This medicine may contain phenylalanine. Check the medication label if you have phenylketonuria (PKU).

Tell your doctor if you are pregnant. Metoclopramide may harm an unborn baby if you use the medicine during late pregnancy.

It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.

Metoclopramide is not approved for use by anyone younger than 18 years old.

How should I use metoclopramide?

Take metoclopramide exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Use the medicine exactly as directed.

A metoclopramide injection is given into a muscle or as an infusion into a vein. A healthcare provider will give the injection, usually during surgery, chemotherapy, or a medical procedure.

Metoclopramide oral is taken for only 4 to 12 weeks.

NEVER USE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. The longer you use metoclopramide, the more likely you are to develop this movement disorder. The risk of this side effect is higher in diabetics and older adults (especially women).

Metoclopramide is usually taken 30 minutes before meals and at bedtime, or only with meals that usually cause heartburn. Follow your doctor’s dosing instructions very carefully.

Do not use two different forms of metoclopramide (such as tablets and oral syrup) at the same time.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

To take the orally disintegrating tablet (ODT):

• Remove a tablet from its blister pack only when you are ready to take the tablet. Use dry hands and take care not to damage a tablet while pushing it out of the blister.
• Place the tablet in your mouth and allow it to dissolve, without chewing or swallowing it whole. You may sip liquid if needed to help swallow the dissolved tablet.

Store at room temperature in a tightly-closed container, away from moisture and heat. Keep the bottle tightly closed.

After you stop taking metoclopramide, you may have unpleasant withdrawal symptoms such as headache, dizziness, or nervousness.

Dosing information

Usual Adult Dose for Nausea/Vomiting:

Postoperative nausea and vomiting:
Parenteral: 10 to 20 mg IM at or near the end of surgery

Usual Adult Dose for Gastroesophageal Reflux Disease:

Oral: 10 to 15 mg up to 4 times a day 30 minutes before meals and at bedtime, depending upon symptoms being treated and clinical response. Therapy should not exceed 12 weeks.

Usual Adult Dose for Small Intestine Intubation:

If the tube has not passed the pylorus with conventional methods in 10 minutes, a single (undiluted) dose may be administered IV slowly over 1 to 2 minutes:
Adults and pediatric patients greater than or equal to 14 years: 10 mg IV as a single dose administered over 1 to 2 minutes.

Usual Adult Dose for Radiographic Exam:

Adults and pediatric patients greater than or equal to 14 years: 10 mg IV as a single dose administered over 1 to 2 minutes to facilitate gastric emptying where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

Usual Adult Dose for Gastroparesis:

During the earliest manifestations of diabetic gastric stasis, oral administration may be initiated. If severe symptoms are present, therapy should begin with IM or IV administration for up to 10 days until symptoms subside at which time the patient can be switched to oral therapy. Since diabetic gastric stasis is often recurrent, therapy should be reinstituted at the earliest manifestation.

Parenteral: 10 mg 4 times daily, IV (slowly over a 1 to 2 minute period) or IM for up to 10 days.

Oral: 10 mg 4 times daily, 30 minutes before meals and at bedtime, for 2 to 8 weeks depending on clinical response.

Usual Adult Dose for Nausea/Vomiting — Chemotherapy Induced:

IV infusion: 1 to 2 mg/kg/dose (depending on the emetogenic potential of the agent) IV (infused over a period of not less than 15 minutes) 30 minutes before administration of chemotherapy. The dose may be repeated twice at 2 hour intervals following the initial dose. If vomiting is still not suppressed, the same dose may be repeated 3 more times at 3 hour intervals.

For doses higher than 10 mg, the injection should be diluted in 50 mL of a parenteral solution. Normal saline is the preferred diluent.

If acute dystonic reactions occur, 50 mg of diphenhydramine hydrochloride may be injected IM.

Usual Adult Dose for Migraine:

Use for treatment of migraine headaches is not an FDA approved indication; however, metoclopramide has shown efficacy in studies at a dose of 10 to 20 mg IV once (used in combination with analgesics or ergot derivatives).

Usual Pediatric Dose for Gastroesophageal Reflux Disease:

Metoclopramide is not approved by the FDA for gastroesophageal reflux disease in pediatric patients; however, the following doses have been studied:

Oral, IM, IV:
Infants and Children: 0.4 to 0.8 mg/kg/day in 4 divided doses

Usual Pediatric Dose for Small Intestine Intubation:

Metoclopramide IV is approved by the FDA for pediatric use to facilitate small bowel intubation by causing gastric emptying where delayed gastric emptying interferes with radiological examination of the stomach and/or small intestine.

If the tube has not passed the pylorus with conventional methods in 10 minutes, a single (undiluted) dose may be administered IV slowly over 1 to 2 minutes:

Less than 6 years: 0.1 mg/kg IV as a single dose

6 to 14 years: 2.5 to 5 mg IV as a single dose

Children greater than 14 years: 10 mg as a single dose

Usual Pediatric Dose for Nausea/Vomiting — Chemotherapy Induced:

Metoclopramide is not approved by the FDA for chemotherapy induced nausea and vomiting in pediatric patients; however, the following doses have been studied:

IV:
1 to 2 mg/kg/dose IV every 30 minutes before chemotherapy and every 2 to 4 hours

Usual Pediatric Dose for Nausea/Vomiting — Postoperative:

Metoclopramide is not approved by the FDA for postoperative nausea and vomiting in pediatric patients; however, the following doses have been studied:
IV:
Children less than or equal to 14 years: 0.1 to 0.2 mg/kg/dose (maximum dose: 10 mg/dose); repeat every 6 to 8 hours as needed
Children greater than 14 years and Adults: 10 mg; repeat every 6 to 8 hours as needed

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . Overdose symptoms may include drowsiness, confusion, or uncontrolled muscle movements.

What to avoid

Drinking alcohol with this medicine can cause side effects.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Metoclopramide side effects

Get emergency medical help if you have signs of an allergic reaction to metoclopramide: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking metoclopramide and call your doctor at once if you have any of these SIGNS OF A SERIOUS MOVEMENT DISORDER, which may occur within the first 2 days of treatment:

• tremors or shaking in your arms or legs;
• uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); or
• any new or unusual muscle movements you cannot control.

Call your doctor at once if you have:

• confusion, depression, thoughts of suicide or hurting yourself;
• slow or jerky muscle movements, problems with balance or walking;
• mask-like appearance in your face;
• a seizure;
• anxiety, agitation, jittery feeling, trouble staying still, trouble sleeping;
• swelling, feeling short of breath, rapid weight gain; or
• severe nervous system reactionvery stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Common metoclopramide side effects may include:

• feeling restless;
• feeling drowsy or tired;
• lack of energy;
• nausea, vomiting;
• headache, confusion; or
• sleep problems (insomnia).

What is Reglan?

Reglan increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines and may help with nausea.

Reglan is used for 4 to 12 weeks to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief.

Reglan is also used to treat gastroparesis (slow stomach emptying) in people with diabetes, which can cause heartburn and stomach discomfort after meals.

Reglan may also be used for purposes not listed in this medication guide.

Warnings

Do not use Reglan if you’ve ever had muscle movement problems after using metoclopramide or similar medicines, or if you’ve had a movement disorder called tardive dyskinesia. You also should not use this medicine if you’ve had stomach or intestinal problems (a blockage, bleeding, or a hole or tear), epilepsy or other seizure disorder, or an adrenal gland tumor (pheochromocytoma).

NEVER USE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use can cause a serious movement disorder that may not be reversible. The longer you use metoclopramide, the more likely you are to develop this movement disorder. The risk of this side effect is higher in diabetics and older adults (especially women).

Before you take Reglan, tell your doctor if you have kidney or liver disease, congestive heart failure, high blood pressure, diabetes, Parkinson’s disease, or a history of depression.

Do not drink alcohol. It can increase some of the side effects of metoclopramide.

Stop using Reglan and call your doctor at once if you have tremors or uncontrolled muscle movements, fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, rapid breathing, depressed mood, thoughts of suicide or hurting yourself, hallucinations, anxiety, agitation, seizure, or jaundice (yellowing of your skin or eyes).

Before taking this medicine

You should not use Reglan if you are allergic to metoclopramide, or if you have:

• tardive dyskinesia (a disorder of involuntary movements);
• stomach or intestinal problems such as a blockage, bleeding, or perforation (a hole or tear in your stomach or intestines);
• epilepsy or other seizure disorder;
• an adrenal gland tumor (pheochromocytoma); or
• if you’ve ever had muscle movement problems after using metoclopramide or similar medicines.

Tell your doctor if you have ever had:

• liver or kidney disease;
• problems with muscle movements;
• congestive heart failure or a heart rhythm disorder;
• high blood pressure;
• seizures;
• breast cancer;
• Parkinson’s disease;
• diabetes; or
• depression or mental illness.

Tell your doctor if you are pregnant before taking metoclopramide.

It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.

Reglan is not FDA-approved for use by anyone younger than 18 years old.

How should I use Reglan?

Take Reglan exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides. Use the medicine exactly as directed.

Reglan should be taken for only 4 to 12 weeks.

NEVER USE REGLAN IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. The longer you use metoclopramide, the more likely you are to develop this movement disorder. The risk of this side effect is higher in diabetics and older adults (especially women).

Reglan is usually taken 30 minutes before meals and at bedtime, or only with meals that usually cause heartburn. Follow your doctor’s dosing instructions very carefully.

Do not use two different forms of metoclopramide (such as tablets and oral syrup) at the same time.

Store at room temperature in a tightly-closed container, away from moisture and heat. Keep the bottle tightly closed.

After you stop taking Reglan, you may have unpleasant withdrawal symptoms such as headache, dizziness, or nervousness.

Dosing information

Usual Adult Dose of Reglan for Gastroesophageal Reflux Disease:

Oral: 10 to 15 mg up to 4 times a day 30 minutes before meals and at bedtime, depending upon symptoms being treated and clinical response. Therapy should not exceed 12 weeks.

Usual Adult Dose of Reglan for Gastroparesis:

During the earliest manifestations of diabetic gastric stasis, oral administration may be initiated. If severe symptoms are present, therapy should begin with IM or IV administration for up to 10 days until symptoms subside at which time the patient can be switched to oral therapy. Since diabetic gastric stasis is often recurrent, therapy should be reinstituted at the earliest manifestation.

Oral: 10 mg 4 times daily, 30 minutes before meals and at bedtime, for 2 to 8 weeks depending on clinical response.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line . Overdose symptoms may include drowsiness, confusion, or uncontrolled muscle movements.

What to avoid

Drinking alcohol with this medicine can cause side effects.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Do not take Reglan with other medications that increase the risk of experiencing extrapyramidal reactions (eg, spasms, muscle contractions, jerky/rigid movements).

Reglan side effects

Get emergency medical help if you have signs of an allergic reaction to Reglan: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop taking Reglan and call your doctor at once if you have any of these SIGNS OF A SERIOUS MOVEMENT DISORDER, which may occur within the first 2 days of treatment:

• tremors or shaking in your arms or legs;
• uncontrolled muscle movements in your face (chewing, lip smacking, frowning, tongue movement, blinking or eye movement); or
• any new or unusual muscle movements you cannot control.

Call your doctor at once if you have:

• confusion, depression, thoughts of suicide or hurting yourself;
• slow or jerky muscle movements, problems with balance or walking;
• mask-like appearance in your face;
• a seizure;
• anxiety, agitation, jittery feeling, trouble staying still, trouble sleeping;
• swelling, feeling short of breath, rapid weight gain; or
• severe nervous system reactionvery stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Common Reglan side effects may include:

• feeling restless;
• feeling drowsy or tired;
• lack of energy;
• nausea, vomiting;
• headache, confusion; or
• sleep problems (insomnia).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Reglan?

Using Reglan with other drugs that make you drowsy can worsen this effect. Ask your doctor before you take opioid pain medication, a sleeping pill, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all your current medicines. Many drugs can interact with metoclopramide, especially:

• cyclosporine (Gengraf, Neoral, Sandimmune);
• digoxin (digitalis, Lanoxin);
• glycopyrrolate (Robinul);
• insulin;
• levodopa (Larodopa, Atamet, Parcopa, Sinemet);
• mepenzolate (Cantil);
• tetracycline (Ala-Tet, Brodspec, Panmycin, Sumycin, Tetracap);
• atropine (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-Scop);
• bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);
• blood pressure medications;
• bronchodilators such as ipratroprium (Atrovent) or tiotropium (Spiriva);
• irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin), or propantheline (Pro-Banthine);
• an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate); or
• medicines to treat psychiatric disorders, such as chlorpromazine (Thorazine), clozapine (Clozaril, FazaClo), haloperidol (Haldol), olanzapine (Zyprexa, Symbyax), prochlorperazine (Compazine), risperidone (Risperdal), thiothixene (Navane), and others.