Parenil Nasal Spray

Indications

Metoclopramide is used to relieve nausea and vomiting, including after surgery, with migraine, and from chemotherapy or radiotherapy. It is also used to treat diabetic gastroparesis, a condition where the stomach empties too slowly in people with diabetes, causing fullness, bloating and vomiting. It is available as tablets, syrup, injection and a nasal spray (the spray is used for diabetic gastroparesis in adults).

How It Works

Metoclopramide blocks dopamine receptors in the part of the brain that triggers vomiting, reducing nausea. In the gut, it increases the movement of the stomach and upper intestine and tightens the valve at the lower end of the food pipe, helping food move on from the stomach more quickly.

Dosage and Administration

Usual adult dose for nausea and vomiting: 10 mg by mouth up to three times daily, for no more than 5 days. The maximum is usually 30 mg a day. For diabetic gastroparesis, tablets or the nasal spray are used as prescribed, usually 30 minutes before meals and at bedtime, for a limited number of weeks. Injections are given by a doctor or nurse. Children and young people should only use it as prescribed by a doctor. Lower doses are needed in kidney or liver disease and in older people.

Interactions

Avoid with Levodopa and other Parkinson's medicines, as they have opposite effects. Antipsychotics increase the risk of movement disorders. Alcohol, sedatives and opioids add to drowsiness. It may change the absorption of other medicines, such as Digoxin (less) and Paracetamol or Ciclosporin (more). Combining with SSRIs or other serotonin medicines may rarely cause serotonin syndrome. Fluoxetine and Paroxetine raise metoclopramide levels.

Contraindications

Do not use if you have a bowel blockage, bleeding or perforation of the stomach or intestine, phaeochromocytoma (a tumour of the adrenal gland), epilepsy, Parkinson's disease, a history of tardive dyskinesia or movement problems from such medicines, or if you are allergic to Metoclopramide. Not for children under 1 year.

Side Effects

Common side effects include drowsiness, tiredness, restlessness, diarrhoea, low mood and weakness. It can cause involuntary movements such as muscle spasms of the face, neck or eyes, especially in young people. Long-term use can cause tardive dyskinesia, a movement disorder that may be permanent. The nasal spray may cause an unusual taste and headache.

Get urgent medical help if you develop uncontrolled movements of the face, tongue, eyes or limbs, high fever with stiff muscles and confusion, a fast or irregular heartbeat, fainting, thoughts of self-harm, or signs of a severe allergic reaction.

Pregnancy and Lactation

It can be used in pregnancy when needed, usually for short periods, on medical advice; use near delivery may cause movement effects in the newborn. It passes into breast milk, so breastfeeding is generally not recommended during treatment; ask your doctor.

Precautions and Warnings

Do not use for longer than recommended because of the risk of tardive dyskinesia. Tell your doctor about depression, heart rhythm problems, kidney or liver disease, high blood pressure or breast cancer. It may cause drowsiness, so avoid driving if affected. Avoid alcohol.

Overdose

Overdose can cause severe drowsiness, confusion, muscle spasms and abnormal movements, and heart rhythm problems. Seek emergency medical help.

Therapeutic Class

Antiemetic and prokinetic agent (dopamine antagonist).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children. Do not freeze the syrup or nasal spray.