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In pediatric patientsthe pharmacodynamics of metoclopramide following oral and intravenous administration are highly variable and a concentration-effect relationship has not been established.
Metoclopramide is contraindicated in patients with pheochromocytoma because the drug may cause a hypertensive crisisprobably due to release of catecholamines from the tumorSuch hypertensive crises may be controlled by phentolamine.
The antiemetic properties of metoclopramide appear to be a result of its antagonism of central and peripheral dopamine receptorsDopamine produces nausea and vomiting by stimulation of the medullary chemoreceptor trigger zoneCTZand metoclopramide blocks stimulation of the CTZ by agents like ldopa or apomorphine which are known to increase dopamine levels or to possess dopamine-like effectsMetoclopramide also abolishes the slowing of gastric emptying caused by apomorphine.
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