Pramin
Generic Name
Metoclopramide
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| pramin 25 mg tablet | ৳ 4.00 | ৳ 40.00 |
Description
Overview of the medicine
Pramin (Metoclopramide) is an anti-emetic and prokinetic agent used to treat nausea, vomiting, and certain gastrointestinal disorders like gastroparesis and heartburn. It works by blocking dopamine receptors in the brain's 'vomiting center' and by speeding up the movement of food through the digestive system.
Uses & Indications
Dosage
Adults
Oral: 10 mg three times daily, 30 minutes before meals and at bedtime. Maximum recommended dose is 0.5 mg/kg/day or 30 mg/day for short-term use (up to 5 days).
Elderly
Reduced doses may be required due to increased sensitivity and potential for adverse effects. Initiate with 5 mg three times daily and adjust based on response and tolerability.
Renal_impairment
Creatinine clearance 10-50 mL/min: 50% of the usual dose. Creatinine clearance <10 mL/min: 25% of the usual dose.
How to Take
Tablets should be taken orally with water, preferably 30 minutes before meals and at bedtime. Do not crush or chew the tablet. Injections are given intramuscularly or slowly intravenously.
Mechanism of Action
Metoclopramide antagonizes dopamine D2 receptors in the chemoreceptor trigger zone (CTZ) of the brain, preventing nausea and vomiting. It also enhances gastrointestinal motility by increasing acetylcholine release, leading to accelerated gastric emptying and intestinal transit.
Pharmacokinetics
Onset
Oral: 30-60 minutes; Intravenous: 1-3 minutes; Intramuscular: 10-15 minutes.
Excretion
Primarily excreted in the urine, mainly as metabolites and about 20% unchanged drug. Small amounts excreted in feces.
Half life
Approximately 5-6 hours.
Absorption
Rapidly and well absorbed from the gastrointestinal tract after oral administration. Bioavailability is about 80% (oral).
Metabolism
Extensively metabolized in the liver by sulfation and glucuronidation. Minor metabolism via N-dealkylation.
Side Effects
Contraindications
- Hypersensitivity to metoclopramide or any component of the formulation.
- Gastrointestinal hemorrhage, mechanical obstruction, or perforation where stimulation of gastrointestinal motility could be dangerous.
- Pheochromocytoma or other catecholamine-releasing paragangliomas (risk of hypertensive crisis).
- History of tardive dyskinesia with metoclopramide or neuroleptics.
- Epilepsy (due to increased seizure risk).
- In patients with Parkinson's disease, as it may worsen symptoms.
- Use in children under 1 year of age (due to increased risk of extrapyramidal disorders).
Drug Interactions
Digoxin
Metoclopramide may reduce the absorption of digoxin.
Cimetidine
Metoclopramide may reduce the absorption of cimetidine.
SSRIs and SNRIs
Increased risk of serotonin syndrome.
Anticholinergics and Opioid Analgesics
May antagonize the effects of metoclopramide on GI motility.
CNS Depressants (e.g., alcohol, sedatives, hypnotics)
Additive sedative effects may occur.
Dopaminergic agonists (e.g., Bromocriptine, Levodopa)
Metoclopramide may antagonize their effects.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include drowsiness, disorientation, extrapyramidal symptoms (e.g., dystonia, oculogyric crisis), and cardiovascular effects (hypotension, bradycardia). Treatment is symptomatic and supportive, including anticholinergic agents (e.g., diphenhydramine) for extrapyramidal symptoms.
Pregnancy & Lactation
Pregnancy Category B. Studies in animals have not shown harm, but human data is limited. Use only if clearly needed after consulting a doctor. Metoclopramide is excreted in breast milk; advise caution in nursing mothers, as it may cause adverse effects in the infant.
Side Effects
Contraindications
- Hypersensitivity to metoclopramide or any component of the formulation.
- Gastrointestinal hemorrhage, mechanical obstruction, or perforation where stimulation of gastrointestinal motility could be dangerous.
- Pheochromocytoma or other catecholamine-releasing paragangliomas (risk of hypertensive crisis).
- History of tardive dyskinesia with metoclopramide or neuroleptics.
- Epilepsy (due to increased seizure risk).
- In patients with Parkinson's disease, as it may worsen symptoms.
- Use in children under 1 year of age (due to increased risk of extrapyramidal disorders).
Drug Interactions
Digoxin
Metoclopramide may reduce the absorption of digoxin.
Cimetidine
Metoclopramide may reduce the absorption of cimetidine.
SSRIs and SNRIs
Increased risk of serotonin syndrome.
Anticholinergics and Opioid Analgesics
May antagonize the effects of metoclopramide on GI motility.
CNS Depressants (e.g., alcohol, sedatives, hypnotics)
Additive sedative effects may occur.
Dopaminergic agonists (e.g., Bromocriptine, Levodopa)
Metoclopramide may antagonize their effects.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include drowsiness, disorientation, extrapyramidal symptoms (e.g., dystonia, oculogyric crisis), and cardiovascular effects (hypotension, bradycardia). Treatment is symptomatic and supportive, including anticholinergic agents (e.g., diphenhydramine) for extrapyramidal symptoms.
Pregnancy & Lactation
Pregnancy Category B. Studies in animals have not shown harm, but human data is limited. Use only if clearly needed after consulting a doctor. Metoclopramide is excreted in breast milk; advise caution in nursing mothers, as it may cause adverse effects in the infant.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24-36 months from the date of manufacture. Refer to the specific product packaging for exact details.
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Expired
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of metoclopramide for its approved indications. Ongoing research may explore new applications or refine existing ones.
Lab Monitoring
- No routine lab monitoring is generally required. However, for long-term use, especially in patients at risk for hyperprolactinemia or tardive dyskinesia, periodic assessment for these conditions is prudent.
Patient Guidelines
- Take Pramin 30 minutes before meals as directed by your doctor.
- Do not use this medicine for longer than 12 weeks due to the risk of tardive dyskinesia.
- Avoid alcohol while taking this medication.
- Inform your doctor about all other medications you are taking, especially other CNS depressants or drugs affecting dopamine.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Pramin can cause drowsiness, dizziness, and other visual disturbances. Patients should be advised not to drive or operate machinery if they experience these side effects.
Lifestyle Advice
- Avoid activities requiring mental alertness, such as driving or operating heavy machinery, until you know how this medicine affects you. Stay hydrated.
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