Half-life is prolonged in patients with renal insufficiency. Metoclopramide stimulates smooth muscle in the GI tract. It is contraindicated in patients with GI obstruction and GI perforation. It should be used cautiously in patients with GI bleeding for similar reasons, but metoclopramide has been used to empty the stomach of blood prior to endoscopy. Metoclopramide is contraindicated in patients with pheochromocytoma because it can stimulate the release of catecholamines, possibly leading to a hypertensive crisis.
Caution also is recommended in patients with existing hypertension.
Metoclopramide should be administered cautiously to patients with a preexisting seizure disorder or parkinsonism. Children and adolescents are more likely to experience extrapyramidal effects. It is recommended that use in pediatrics be restricted to intubation of the small intestine. The occurrence of CNS depression also indicates cautious use in patients with a history of major depression. Since metoclopramide is structurally related to procainamide, metoclopramide should be used cautiously in patients with a known procainamide hypersensitivity.