Reglan

Perinorm

Generic Name

Metoclopramide

About Perinorm

Perinorm is a medication used for several different purposes. As an antiemetic agent, Perinorm is used to treat nausea and vomiting. Most often, it is given to patients suffering from these symptoms because of chemotherapy or exposure to anesthetics. The medication may also be used to treat migraine sufferers who count nausea among their symptoms.

As a prokinetic agent, Perinorm is used to treat other digestive problems, including diabetic gastroparesis, persistent heartburn and gastric reflux disease. The medication treats these disorders by activating stomach contractions and allowing food to move more easily from the stomach to the intestines. Perinorm may also be used to help empty the stomach for certain x-rays or imaging tests or to help tubes pass through the intestine.

Metoclopramide and Tardive Dyskinesia

A 2004 study conducted by medical professionals at the Veterans Administration and the Food and Drug Administration (FDA) demonstrated that metoclopramide could cause the development of a serious movement disorder known as tardive dyskinesia (TD). The study noted the disorder is most often observed in patients who took metoclopramide for more than 12 weeks, and that elderly women may be at particularly high risk of developing the condition.

TD is a potentially irreversible condition characterized by repeated, involuntary body movements. These motions include arm and leg spasms, facial tics, eye blinking, grimacing, lip smacking and tongue protrusion, among others. Though a few medications have been known to lessen the movements, there is currently no cure for the disorder. In some cases, TD symptoms may stop or lessen after metoclopramide use is halted; however, in others, symptoms continue even after treatment with the medication has been discontinued.

Metoclopramide Today

While some have called for the removal of metoclopramide from the market, the drug continues to remain in use in certain popular medications such as Reglan. In 2009, the FDA required all metoclopramide medications to carry a black box warning informing consumers and health care professionals of the risk of TD. The warning states metoclopramide should be used with extreme caution and for no more than 12 weeks, except in rare cases in which the potential benefits of continued treatment outweigh the risks of long-term use of the medication.

Dosage

Dosages of Perinorm may vary among patients. Those using the medication for nausea may only need to take it when needed. In general, however, when used to treat heartburn or other gastric disorders, the medication is taken three to four times a day, usually 30 minutes before meals. Perinorm should be taken with a full glass of water.

Missed doses of Perinorm should be taken as soon as remembered. However, if it is almost time for the patient's next dose, the missed dose should be skipped. Two doses should never be taken at the same time to compensate for a missed dose.

Contraindications

Patients with certain conditions should not take Perinorm. Do not take the medication if you have any of the following:

  • Bleeding, obstruction or injury of the stomach
  • Epilepsy or other seizure disorders
  • Adrenal gland tumors

Patients with any of the following other conditions should use Perinorm 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

Nursing women should not take Perinorm, as the medication can pass into breast milk. Women who are pregnant or may become pregnant should also not take Perinorm, as no conclusive studies have assessed the potential effects of metoclopramide on a developing fetus.

Drug Interactions

There are a number of drugs that can negatively interact with Perinorm and cause serious health problems. These include, but are not limited to:

  • Acetaminophen
  • Monoamine oxidase (MAO) inhibitors
  • Insulin
  • Digoxin
  • Cyclosporine
  • Tetracycline
  • Levodopa
  • Cimetidine
  • Opiate pain relievers (e.g., morphine, oxycodone)
  • Sleeping aids

Perinorm 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 medicines, vitamins or supplements before beginning treatment with a new medication.

Side Effects

In addition to tardive dyskinesia, Perinorm may also cause the following serious side effects:

  • Neuroleptic malignant syndrome (NMS)
  • Seizures
  • Irregular heartbeat
  • Liver problems
  • Endocrine problems
  • Severe agitation
  • Jaundice

Less serious side effects of the drug include:

  • Nausea
  • Diarrhea
  • Confusion
  • Headache
  • Dizziness
  • Drowsiness
  • Urinary frequency due to fluid retention
  • Menstrual changes

 

Sources

  1. Mayo Clinic, http://www.mayoclinic.com/health/drug-information/DR600921
  2. 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
  3. U.S. Food and Drug Administration, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm149533.htm
  4. U.S. National Library of Medicine, http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684035.html

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