Maxolon injection (metoclopramide)

How does it work?

Maxolon injection contains the active ingredient metoclopramide hydrochloride, which is a type of medicine called a dopamine antagonist. (NB. Metoclopramide is also available without a brand name, ie as the generic medicine.) Metoclopramide is an antisickness medicine, though it also has other uses due to its action on the gut.

Metoclopramide works primarily by blocking dopamine receptors found in an area of the brain known as the chemoreceptor trigger zone (CTZ). The CTZ is activated by nerve messages from the stomach when an irritant is present. It is also activated directly by agents circulating in the blood, for example anti-cancer medicines. Once activated, it sends messages to another area of the brain, the vomiting centre, which in turn sends messages to the gut, causing the vomiting reflex.

Blocking the dopamine receptors in the CTZ prevents nausea messages from being sent to the vomiting centre. This reduces the sensation of sickness and prevents vomiting.

Metoclopramide also acts in the upper end of the digestive system, where it enhances the action of a natural chemical called acetylcholine. Increasing the action of acetylcholine results in the tightening of the muscles at the entry to the stomach, relaxation of the muscles at the exit of the stomach and increased contraction of the muscles in the stomach itself. These actions speed the passage of food through the stomach into the intestine, which physically helps to prevent vomiting.

Both actions make metoclopramide useful in treating nausea and vomiting due to many causes, including anti-cancer chemotherapy and radiotherapy, various digestive disorders, heart failure, following surgery and anaesthetics, and in migraine.

Due to its action on the gut, metoclopramide also has several other uses. It is useful in migraine, not only for relieving nausea, but also because during a migraine attack stomach emptying is slowed, which can prevent painkillers taken by mouth from being absorbed. Metoclopramide speeds up the passage of painkillers from the stomach to the intestine, from where they are absorbed to relieve the headache.

Metoclopramide is often given before investigative procedures in hospital for its action on the gut, for example it helps to speed the passage of a barium meal through the gut.

Metoclopramide can also be used to restore normal muscle tone and function to the gut following surgery and in various digestive disorders. This helps relieve symptoms such as indigestion, pain, bile regurgitation, flatulence, acid reflux and heartburn.

Maxolon injection may be administered into a muscle (intramuscularly) or vein (intravenously).

What is it used for?

In adults over 20 years of age metoclopramide is used for the following conditions:

nausea and vomiting due to digestive disorders, anti-cancer chemotherapy, heart failure, deep X-ray or cobalt therapy and following general anaesthetics

relief of digestive symptoms such as indigestion, heartburn, flatulence, sickness, bile regurgitation and stomach pain due to conditions such as peptic ulcer, hiatus hernia, gallstones, reflux oesophagitis, or inflammation of the stomach or small intestine (gastritis or duodenitis)

relieving nausea and vomiting, and assisting the absorption of painkillers in migraine

to assist hospital investigative procedures on the gut (eg barium meal, duodenal intubation)

to help restore normal stomach emptying after surgery.

Use in patients under 20 years of age is restricted to the following conditions:

severe persistent vomiting where the cause is known

vomiting due to chemotherapy or radiotherapy

as an aid to hospital investigative procedures on the gut (gastro-intestinal intubation)

as part of a pre-med before an operation to prevent nausea and vomiting.

Warning!

This medicine may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.

This medicine may increase the rate of absorption of alcohol and increase its blood level and effect.

If vomiting persists despite taking this medicine you should consult your doctor.

Use with caution in

Children or young adults under 20 years of age.

Elderly people.

Severely decreased kidney function.

Severely decreased liver function.

Epilepsy.

People taking antipsychotic medicines or certain other medicines that act in the brain (see end of factsheet for more details).

Hereditary blood disorders called porphyrias.

History of atopic allergies such as eczema, hayfever or asthma.

Not to be used in

People with bleeding in the stomach or intestines (gastrointestinal haemorrhage).

People with an abnormal hole in the stomach or intestines (gastrointestinal perforation).

People with a blockage of the stomach or intestines (gastrointestinal obstruction).

First three to four days following certain types of gut surgery (eg pyloroplasty or gut anastomosis).

Tumour of the adrenal gland (phaeochromocytoma).

Breastfeeding.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine is not known to be harmful when used by pregnant women, but as with all medicines it should be used with caution during pregnancy, and only when considered essential, particularly during the first trimester. Seek medical advice from your doctor.

This medicine passes into breast milk. Women who are breastfeeding should not use this medicine. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Abnormal movements of the hands, legs, face, neck and tongue, eg tremor, twitching, rigidity (extrapyramidal effects).

High blood prolactin (milk producing hormone) level (hyperprolactinaemia). Sometimes this can lead to symptoms such as breast enlargement, production of milk and stopping of menstrual periods.

Drowsiness.

Restlessness.

Confusion.

Anxiety.

Diarrhoea.

Skin reactions such as rash and itch.

Slow heart rate (bradycardia).

Rhythmical involuntary movement of the tongue, face, mouth and jaw, which may sometimes be accompanied by involuntary movements of the arms and legs (tardive dyskinesia).

High temperature combined with falling levels of consciousness, paleness, sweating and a fast heart beat (neuroleptic malignant syndrome). Requires stopping the medicine and immediate medical treatment.

Depression.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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