Reglan

Pylomid

Generic Name

Metoclopramide

About Pylomid

Pylomid is an antiemitic drug used to control nausea and vomiting. The medication is often given post-operatively to ease nausea caused by anesthesia, and is also commonly prescribed for patients undergoing chemotherapy. Pylomid may also be given along with aspirin or another pain reliever to alleviate nausea experienced in patients with severe migraine headaches.

As a prokinetic drug, Pylomid is used to treat gastric stasis. The medication works by increasing the rate at which the stomach and intestines move during the process of digestion and the rate at which the stomach empties food into the intestines. Pylomid may also be prescribed for the treatment of persistent heartburn and gastric reflux disease. Additionally, Pylomid may be used to ease lower intestinal intubation and to facilitate x-ray exams of the stomach and lower intestine.

Metoclopramide and Tardive Dyskinesia

Metoclopramide drugs like Pylomid, Reglan, Octamide and others are designed to aid patients with certain digestive problems. However, the medications have come under scrutiny in recent years because of a particularly serious side effect known as tardive dyskinesia (TD). TD is a potentially irreversible condition characterized by uncontrolled body movements. Patients with TD may experience excessive eye blinking, lip smacking, tongue protrusion, leg and arm spasms, grimacing, tics and other unwanted motions.

A study published in 2004 by members of the U.S. Food and Drug Administration and other agency partners illustrated that patients undergoing long-term treatment with metoclopramide were at high risk of developing TD. Elderly women, as well as patients with pre-existing conditions such as diabetes, psychosis and brain atrophy may be at particular risk of the condition. Other patients without these conditions are also at risk of developing the disorder, even with short-term use of metoclopramide.

Metoclopramide Today

While some have called for the removal of metoclopramide from the market, the medication continues to remain in use. 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 the metoclopramide should be used with caution and for no longer than 12 weeks, except in rare cases in which the potential benefits of continued treatment outweighs the risks of long-term use.

Dosage

Pylomid is most commonly prescribed in a pill form, but may also be available in a liquid. Pylomid dosages may vary among patients.

For post-operative nausea, the medication may only be given once or twice. Long-term use of Pylomid is most common when the drug is prescribed for the treatment of heartburn and other gastric problems. Patients using the medication for these purposes generally take three or four doses of the medication per day, approximately 30 minutes before meals.

Missed doses should be taken as soon as remembered. However, if it is almost time for a patient's next scheduled dose, the forgotten dose should be skipped. Patients should never take two doses of Pylomid at once to compensate for a missed dose.

Contraindications

Patients with any of the following conditions should not take Pylomid:

  • Epilepsy or other seizure disorders
  • Stomach bleeding or obstruction
  • Adrenal gland tumors (pheochromcytoma)

Patients with the following conditions should use Pylomid 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

Women who are nursing should not take Pylomid or any other metoclopramide drug. Women who are pregnant or may become pregnant should also not use Pylomid, as the potential effects of the medication on a developing fetus are unknown.

Drug Interactions

There are a number of drugs that can negatively interact with Pylomid. These include, but are not limited to:

  • Monoamine oxidase (MAO) inhibitors
  • Acetaminophen
  • Narcotic pain relievers
  • Cyclosporine
  • Digoxin
  • Tetracycline
  • Insulin
  • Levodopa
  • Sleeping pills

The drug may also increase the depressant effects of alcohol.

Pylomid 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

Serious side effects of Pylomid and other metoclopramide drugs include:

  • Tardive dyskinesia
  • Seizures
  • Agitation and anxiety
  • Hallucinations
  • Jaundice of the eyes and skin
  • Irregular heartbeat
  • Insomnia

Less serious side effects may include, but are not limited to:

  • Diarrhea
  • Nausea
  • Fluid retention
  • Menstrual changes
  • Confusion
  • Reduced concentration
  • Headache
  • Drowsiness
  • Dizziness

 

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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