No. I never used it. As it is not a safer drug even.

No la utilizamos. De hecho en nuestro hospital esta prohibido el uso de la metoclopramida.

Metoclopramid is indeed controversial drug and there is a question of safety. But, as we lack any other registered prokinetic drug, in special situation, in hospitalized patients who are close monitored, we have used it in past decade few times. Mostly for our severe underweight patients with anorexia nervosa, for short time and with no adverse effects.

prevention? no. Treatment? yes, on a short term basis. Still safer than erythromycin. Only 10% of critically ill trauma patients experience gastric feeding intolerance requiring prokinetic therapy. 20% for those with traumatic brain injury.

Dickerson RN et al. Disparate response to metoclopramide therapy for gastric feeding intolerance in trauma patients with and without traumatic brain injury. JPEN Journal of Parenteral and Enteral Nutrition.2009;33(6):646-655.

Yes I did, years ago, but I preferred the even more effective prokinetc drug cisapride, which also disappeared from the market, because of some potential cardiac side effects. But: Cispride was much more effective for esophageal and antral dysmotility (the latter we need for gastric emptying with naso-gastric tube feeding), and metoclopramide showed no clear cut benefit compared with domperidone.

One should not forget, that we are talking about critically ill patients, and not about chronic use. So, during years of ICU experience I never met neurologic disturbances within short time usage. But another alternative might be the naso-duodenal or naso-jejunal tube feeding, e.g. "bypassing" the antral paralysis instead of drug experiments with not effective enough substances.

No, never.

In the past we have used domperidone but we have stop using it for a several years after being convinced that it was not usefull at all.

We use it everyday for the treatment of gastric intolerance to enteral feeding (4*10mg/day) (mixed population). We never had any severe documented side effects. However, it could be difficult to distinguish side effects of this drug among the others or among the various symptoms of a critically ill patients supported by mechanical ventilation. We also regularly associate erythromycin (3*250mg/d) if it is not efficacious. As R.Dickerson cited above, it is recommended to restrict its use to a short period since after 5 days a tachyphylaxis develops (Nguyen et al publication).

not usefull for PONV

Si no hay contraindicación para su uso lo utilizamos en los pacientes que iniciamos nutrición enteral nasogastrica

Like it or not, metoclopramide remains ubiquitous, relatively safe and moderately effective - and it stands alone as in its primary drug class as it possesses pro-motility side effects.

I'm agree with Robert Gerhardt. In your ICU, we use Erythromycine in first line because it's probably more efficious (Reignier et al PMID: 12072674) but sometimes in second line metoclopramide is used after controle of QT interval.

In our ICU, we still use metoclopramide as a treatment gastrointestinal prokinetic in patients without neurological disorders. In specific situation such as patients with Parkinson disease, we use erythromycin . We do not have experience major side effects related to this drug. I agree with Robert Gerhardt's opinion

Thank you all for your interesting answers. These are controversial too!! It seems that we are very limited when our patients need an IV treatment with a promotility agent: metoclopramide or erythromycin. We still use metoclopramide as a first line treatment in our intolerant patients with enteral nutrition. We have not observed significant neurologic effects of this treatment.

Thank you again.

Thanks Dr. Mateu-de Antonio. I totally agree with you.

With attention to current literature, there is no obvious contraindication for use this agents in this mean and also I guess it has beneficial effects on GI intolerance.

Yes I do use metoclopramide in ICU patients of Trauma and neurology who do not tolereate gastric feeds. I found it quite safe and moderately effective thats why we use some time combination of Metaclopramide and Erythromycin antibiotic for its prokinetic action only. I found this combination very effective in cases of gastric feed intolerence.

We use tripple therapy, with iv metoclopramide , iv erythromycine and naloxone 0,2mg*3 orally.

Yes. We used intravenous metoclopramide 20mg/day continuously to the victim of criticality accident in Tokaimura every day at least the first month of admission under careful observation for the side effects, including extrapyramidal and endocrinological symptoms, which did not occur. Considering the β half-life (4.5hr), effective and toxic blood concentration of metoclopramide, we selected continuous administration, never used bolus.

Conference Paper International Symposium on The Criticality Accident in Tokai...

I think the use of metoclopramide is very extended in spanish ICUs. If you use it carefully, is difficult but not impossible to have problems (I remember an asystole by a fast intravenous injection). Is there a better alternative ?

I have used metoclopramide in the ICU patients not tolerating feeds but we have used it for short period of time only (2-3 days) which i believe is very short time period to develop any kind of complications. I do recall using it on a patient after the whipples procedure which did not help her much however. I have not noticed any kind of complications in any patients so far.

YES, we use methclopramide in early postoperative period of critical ill patient , but just for a short period of time, esspecially in diabetic patients for which we know that they have gastoparesis, and that for the moment we dont have any other similar poduct who will help us to start enteral nutrition. We use it also after liver transplant and we can say that feeding is going fast and till today we didnt have any negative adverse effect of mthclopramide

We often use metoclopramide in our ICU setting. We are mainly surgical ICU, dealing with patients after extensive abdominal procedures ( ''abdominectomies'' as we call it) and many of them also having a load of co-mobidities, diabetes being the first on the list. If the surgical cause of hipomotility or GI paresis is ruled out, in order to get the peristaltics back on track we first start with metoclopramide. As far as my limited experience is concerned ( 5years in this field) we did not have any neurological side effects of this drugs that we were aware of. Of course, if primarily dealing with patients that already have present neurological disorder we tend to avoid this medicine. Next two in line for us are erytromicine and last-if not contraindicated- prostigmine. If none of the mentioned did not show efficiency, reevaluation of the state is done because then there is high suspicion of surgical complicatations.

Nosotros lo usamos y vigilamos estrechamente efectos secundarios, si hay alguna contraindicación absoluta o interacción medicamentosa se suspende inmediatamente

We use Erythromycin in first step.

Metoclopramide also can be used for this problem.

I totally agree with Dr Dickerson. Not to prevent but yes to treat.

The use of Metoclopramide at times can result in a false positive picture of a patients tolerance of nasogastric feed. With the use of this drug to aid absorption of feed can result in it's early withholding of the drug due to it's cautionary use, with possible side effects being in mind. Past experience has shown many patients experiencing high aspirates once Metoclopramide was stopped, which is potentially problematic when placing patients on sedation holds. Erythromycin has been shown to be just as effective, even at lower doses than the recommended dose. Using clinical judgement in assessing your patients absorption should not be replaced by looking at figures on a computer or patient chart! Side effects can be easily missed, but relevant ones are treated accordingly, whether they are recognized as being Drug related or not!

We usually start with erythromycin,if not improved we add metoclopramide.

If no response in 3 days i stopp it

I agree with Dr Ghaleb. We use erythromycin following a care protocol only to treat and not to prevent. The recent publication of Reignier and coll. in JAMA describe very well how they do.

Yes we use metaclopramide for failure to enterally feed patient cohort.  This treatment is first line in our failure to feed protocol.  Erythromycin is then implemented. we have certainly seen neurological adverse reactions to metaclopramide.  Easily missed if not watching for them. We use is with caution but it is typically our first line.

Same point of view, same practical approach.

Yes I also use metoclopramide in enterally fed ICU patients