Metoclopramide Nasal Spray

Why is this medicine prescribed?

Metoclopramide nasal spray is used to treat gastroparesis (slow stomach emptying). Metoclopramide is in a class of medications called prokinetic agents. It works by speeding the movement of food through the stomach and intestines.

Are there other uses for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Metoclopramide nasal spray comes as a solution (liquid) to spray into the nose. It is usually sprayed into one nostril 4 times a day, 30 minutes before each meal and at bedtime.

Use metoclopramide nasal spray exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

To use the nasal spray, follow these steps:

1. Remove the cap and the safety clip from the nasal spray pump.
2. If you are using the nasal spray pump for the first time, you must prime the pump. Hold the bottle with your thumb at the base and your index and middle fingers on the white shoulder area. Point the bottle upright and away from your eyes. Press down and release the nozzle to release 10 sprays into the air away from the face. If you have not used your nasal spray for more than 14 days, prime the pump again with 10 sprays.
3. Close one nostril by gently placing your finger against the side of your nose, tilt your head slightly forward and, keeping the bottle upright, insert the nasal tip into the other nostril. Point the tip toward the back and outer side of the nose. Use your forefinger and middle finger to press firmly down on the nozzle and release a spray. Following the spray, sniff gently and breathe out slowly through your mouth.
4. Wipe the applicator with a clean tissue and cover it with the cap.

If you are not sure that the nasal spray entered your nose, do not repeat the dose, and continue your regular dosing schedule.

What special precautions should I follow?

Before using metoclopramide nasal spray,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any other drugs, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• you should know that some medications should not be taken with metoclopramide. Make sure you have discussed any medications you are currently taking or plan to take before starting metoclopramide with your doctor and pharmacist. Before starting, stopping, or changing any medications while using metoclopramide please get the advice of your doctor or pharmacist.
• tell your doctor if you have or have ever had blockage, bleeding, or a tear in your stomach or intestines; pheochromocytoma (tumor on a small gland near the kidneys); problems controlling or moving your muscles after taking any other medication; or seizures. Your doctor will probably tell you not to use metoclopramide nasal spray.
• tell your doctor if you have or have ever had Parkinson's disease (PD; a disorder of the nervous system that causes difficulties with movement, muscle control, and balance) or other conditions that affect muscle control and movement;; high blood pressure; depression or other mental illness; breast cancer; asthma; glucose-6-phosphate dehydrogenase (G-6PD) deficiency (an inherited blood disorder); NADH cytochrome B5 reductase deficiency (an inherited blood disorder); heart failure, irregular heartbeat, or other heart problems; or liver or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using metoclopramide nasal spray, call your doctor.
• you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• talk to your doctor about the risks and benefits of using metoclopramide nasal spray if you are 65 years of age or older. Older adults should not usually start using metoclopramide, because it is not as safe or effective as other medications that can be used to treat those conditions.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using metoclopramide nasal spray.
• ask your doctor about the safe use of alcohol while you are using this medication. Alcohol can make the side effects of metoclopramide worse.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget to take a dose?

Skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help . If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• drowsiness
• confusion
• seizures
• unusual, uncontrollable movements
• bluish coloring of the skin

What side effects can this medicine cause?

Metoclopramide may cause side effects. Tell your doctor if any of these symptoms or those in the SPECIAL PRECAUTIONS section are severe or do not go away:

• unpleasant taste in mouth
• excessive tiredness
• weakness
• headache
• dizziness
• breast enlargement or discharge
• decreased sexual ability
• frequent urination, inability to control urination

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• tightening of the muscles, especially in the jaw or neck
• depression, thinking about harming or killing yourself
• fever, muscle stiffness, confusion, sweating, or changes in heartbeat
• restlessness, agitation, nervousness or jitteriness, pacing, foot tapping
• difficulty falling asleep or staying asleep
• slow or stiff movements
• blank facial expression
• uncontrollable shaking of a part of the body
• difficulty keeping your balance
• rash, hives, swelling of the eyes, face, lips, tongue, mouth, throat, arms, hands, feet, ankles, or lower legs
• difficulty breathing or swallowing
• high-pitched sounds while breathing

Metoclopramide may cause other side effects. Call your doctor if you have any unusual problems while you are using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online ( https://www.fda.gov/Safety/MedWatch ) or by phone ( 1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the bottle it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Dispose of the bottle 4 weeks after opening, even if there is some solution left in the bottle.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.

What other information should I know?

Keep all appointments with your doctor.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.