Introduction
Maxil is a prescription medicine used to treat nausea, vomiting, and prevent the feeling of fullness during or shortly after a meal. It also treats stomach discomfort, or heartburn caused by the flow of the stomach contents back into your food pipe.
Maxil is taken before meals preferably at bedtime in a dose and duration as advised by the doctor. The dose you are given will depend on your condition and how you respond to the medicine. You should take this medicine until your doctor tells you to stop. Let your doctor know about all other medications you are taking as some may affect, or be affected by this medicine.
The most common side effects are restlessness, fatigue, and lack of energy. Most of these are temporary and usually resolve with time. Contact your doctor straight away if you are at all concerned about any of these side effects. It also causes drowsiness, so do not drive or do anything that requires mental focus until you know how this medicine affects you. Avoid drinking alcohol while taking this medicine as it can worsen your sleepiness. This medicine may also cause diarrhea, so it is better to take plenty of fluids while taking this medicine as it may help to prevent dehydration.
Before taking this medicine, you should let your doctor know if you have liver or kidney problems. Pregnant or breastfeeding women should also consult their doctor.
Uses of Maxil
- Nausea
- Vomiting
- Indigestion
Side effects of Maxil
Common
- Restlessness
- Sleepiness
- Fatigue
How to use Maxil
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Maxil is to be taken empty stomach.
How Maxil works
Maxil is a prokinetic. It works on the region in the brain that controls vomiting. It also acts on the upper digestive tract to increase the movement of the stomach and intestines, allowing food to move more easily through the stomach.
What if you forget to take Maxil?
If you miss a dose of Maxil, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
Indication
Gastro-oesophageal reflux disease, Diabetic gastric stasis, Nausea and vomiting associated w/ cancer chemotherapy or radiotherapy, Postoperative nausea and vomiting
Administration
Should be taken on an empty stomach. Take ½ hr before meals.
IV Administration
NS is preferred diluent because drug is most stable in this solution
Dose <10 mg: IV push over 1-2 minutes
Dose >10 mg: Dilute in 50 mL D5W or NS, and infuse over at least 15 minutes
Adult Dose
Oral
Diabetic gastric stasis
Adult: 10 mg 4 times daily for 2-8 wk.
Nausea and vomiting associated with cancer chemotherapy or radiotherapy
Adult: 10 mg, up to tid. Max duration: 5 days.
Gastro-oesophageal reflux disease
Adult: 10-15 mg 4 times daily, depending on severity of symptoms. If symptoms are intermittent, may give single doses of 20 mg prior to provoking situation. Max duration: 12 wk.
Elderly: 5 mg/dose.
Parenteral
Diabetic gastric stasis
Adult: 10 mg 4 times daily by IM inj or slow IV inj over 1-2 min for up to 10 days. Convert to oral admin when symptoms subside sufficiently.
Intravenous
Prophylaxis of chemotherapy-induced nausea and vomiting
Adult: For highly emetogenic drugs/regimens: Initially, 2 mg/kg by slow inj over at least 15 min, 30 min before chemotherapy. Repeat 2 hrly for 2 doses, then 3 hrly for 3 doses. For less emetogenic drugs/regimens: 1 mg/kg may be used. Max duration: 5 days.
Premedication for radiologic examination of the upper gastrointestinal tract; Intubation of the small intestine
Adult: 10 mg as a single dose by slow inj over 1-2 min.
Parenteral
Prophylaxis of postoperative nausea and vomiting
Adult: 10 mg as a single dose by IM or slow IV inj over at least 3 min.
Hepatic impairment: Severe: Reduce dose by 50%.
Child Dose
Small Bowel Intubation/Radiologic Examination of Upper GI Tract
<6 years old: 0.1 mg/kg IV over 1-2 minutes
6-14 years old: 2.5-5 mg IV over 1-2 minutes
>14 years old: 10 mg IV over 1-2 minutes
Gastroesophageal Reflux Disease
Neonate: 0.15 mg/kg IV q6hr
Infant: 0.1 mg/kg IV/IM/PO q6-8hr 30 minutes before meals and at bedtime
Not to exceed 0.3-0.75 mg/kg/day
Diabetic Gastroparesis
<6 years old: 0.1 mg/kg PO q8hr; not to exceed 0.1 mg/kg
>6 years old: 0.5 mg/kg/day PO divided q8hr
Postoperative Nausea & Vomiting
0.1-2 mg/kg IV q6-8hr PRN
Chemotherapy-Induced Nausea & Vomiting
1-2 mg/kg IV (infused over at least 15 minutes) 30 minutes before chemotherapy; repeat q2-4hr; pretreatment with diphenhydramine decreases risk of extrapyramidal adverse effects
Renal Dose
Renal impairment: CrCl <40 mL/min, decrease dose by 50%; CrCl <10 mL/min, decrease dose by 75%
Contraindication
GI haemorrhage, mechanical obstruction or GI perforation; confirmed or suspected pheochromocytoma; history of neuroleptic or metoclopramide-induced tardive dyskinesia; epilepsy, Parkinson's disease; history of methaemoglobinaemia w/ metoclopramide or of NADH cytochrome-b5 deficiency. Concomitant use w/ levodopa or dopaminergic agonists.
Mode of Action
Metoclopramide enhances the motility of the upper GI tract and increases gastric emptying without affecting gastric, biliary or pancreatic secretions. It increases duodenal peristalsis which decreases intestinal transit time, and increases lower oesophageal sphincter tone. It is also a potent central dopamine-receptor antagonist and may also have serotonin-receptor (5-HT3) antagonist properties.
Precaution
Patients w/ underlying neurological conditions, cardiac conduction disturbances, uncorrected electrolyte imbalance, bradycardia. Children, elderly. Renal or hepatic impairment, porphyria, epilepsy, Parkinson's disease, history of depression. Ability to drive or operate machineries may be impaired. Pregnancy and lactation. Monitor patients on prolonged therapy. Increased risk of tardive dyskinesia in patients on prolonged or high-dose treatment.
Lactation: Drug crosses into breast milk; use caution; concern may be warranted according to American Academy of Pediatrics
Side Effect
>10%
Extrapyramidal symptoms (dystonic reactions in 25% of young adults 18-30 years old)
1-10%
Fatigue (2-10%),Restlessness (10%),Sedation (10%),Headache (4-5%),Dizziness (1-4%),Somnolence (2-3%)
Frequency Not Defined
Diarrhea,Nausea,Galactorrhea,Gynecomastia,Impotence,Menstrual disorders,Neuroleptic malignant syndrome,Hematologic abnormalities
Potentially Fatal: Neuroleptic malignant syndrome; cardiac conduction disorders may occur with IV dosage form.
Interaction
Increased sedative effects with CNS depressants. GI effects antagonised by antimuscarinics and opioids. Reduces absorption of digoxin. Increases absorption of ciclosporin, levodopa, aspirin, paracetamol. Interferes with hypoprolactinaemic effect of bromocriptine. Inhibits serum cholinesterase and prolongs neuromuscular blockade produced by suxamethonium and mivacurium.
Potentially Fatal: Serotonin syndrome with sertraline (SSRI).