Emend vs. Reglan for Post-Surgical Care and Heartburn: Important Differences and Potential Risks.

Key takeaways

Emend (aprepitant) and Reglan (metoclopramide) are both used to manage nausea and vomiting, but they work in different ways and are used for different conditions. Emend (aprepitant) is a neurokinin 1 (NK1) receptor antagonist that prevents nausea and vomiting caused by chemotherapy, while Reglan (metoclopramide) is a dopamine antagonist used to treat gastroesophageal reflux disease (GERD) and diabetic gastroparesis. Emend is taken for a short period (three days) during chemotherapy cycles, whereas Reglan is taken multiple times a day for up to three months. Emend is available as capsules and oral suspension, while Reglan comes in various forms, including tablets, liquid, and nasal spray. Reglan has a black box warning for tardive dyskinesia, a serious movement disorder, making it less favorable for long-term use. Emend, on the other hand, has many drug interactions but does not carry the same severe risk of movement disorders. Both medications are available in generic forms, making them more affordable options.

Emend

(aprepitant)

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Metoclopramide

(Reglan)

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Summary for Emend

Prescription only

Emend (aprepitant) is a medication that's used to prevent nausea and vomiting caused by certain anti-cancer medications (chemotherapy). It's usually given an hour before your chemotherapy treatment on days 1 through 3. Emend (aprepitant) is available as capsules for people 12 years and older. It's also available as an oral solution for adults who can't swallow and for younger children. Common side effects of Emend (aprepitant) include feeling tired and diarrhea.

Indications for Emend

Prevention of nausea and vomiting caused by certain chemotherapy; taken along with dexamethasone and a serotonin antagonist (e.g., ondansetron (Zofran))

Pros and Cons for Emend

Pros

Might work well for people who didn’t see benefits with other antiemetics
Safe to take for children 6 months and older
Available as an oral solution, which is helpful for people who have trouble swallowing
Available as a lower-cost generic medication

Cons

Only prevents nausea and vomiting; can't treat nausea and vomiting if you already have symptoms
Not for long-term use (only for first 3 days of each chemotherapy cycle)
Many interactions with other medications, such as hormonal birth control and benzodiazepines

Common Side Effects for Emend

Adults

Tiredness (13%)
Diarrhea (9%)
Weakness (7%)
Indigestion (7%)
Belly pain (6%)
Hiccups (5%)

Children between 6 months to 17 years old

Lower white blood cell count (13%)
Headache (9%)
Diarrhea (6%)
Low appetite (5%)
Cough (5%)
Tiredness (5%)
Dizziness (5%)
Lower red blood cell count (5%)

Warnings for Emend

Interactions with other medications

Summary for Reglan

Prescription only

Metoclopramide (Reglan) is FDA-approved to treat gastroesophageal reflux disease (GERD), as well as gastroparesis in people with diabetes. Providers might also prescribe it off-label for morning sickness during pregnancy and nausea and vomiting caused by chemotherapy. But metoclopramide (Reglan) isn’t a first-choice medication for these conditions because it has a black box warning for a serious side effect called tardive dyskinesia. Metoclopramide (Reglan) can interact with some commonly prescribed medications, such as risperidone (Risperdal) and quetiapine (Seroquel).

Indications for Reglan

Delayed stomach-emptying caused by diabetes (diabetic gastroparesis)
Severe acid reflux (gastroesophageal reflux disease or GERD) when other medications haven’t worked

Pros and Cons for Reglan

Pros

Available as a lower-cost generic medication
Available in many forms including tablet, fast-melting tablet, liquid, nasal spray, and injection
Typically starts to work in 30 minutes to 1 hour
A possible option during pregnancy

Cons

Shouldn’t be used in children or for more than 12 weeks because of a higher risk of serious side effects
Needs to be taken multiple times a day
Interacts with a lot of medications such as antipsychotics, antidepressants, and opioids
Can't be used if you have Parkinson's disease, seizures, or stomach blockages or bleeds

Common Side Effects for Reglan

Restlessness (10%)
Drowsiness (10%)
Lack of energy (10%)
Tiredness (10%)

Warnings for Reglan

Difficulty controlling muscle movements (tardive dyskinesia)
Other conditions with uncontrolled muscle movements (dystonia, Parkinsonian symptoms, and restlessness)
Neuroleptic malignant syndrome (NMS)
Depression and suicidal thoughts and behavior
High blood pressure
Swelling in arms, legs, or around the belly
High prolactin levels