Gimoti
Gimoti (metoclopramide) is a nasal spray used to treat diabetic gastroparesis in adults who have diabetes. It belongs to a group of medications called dopamine antagonists. The usual dose is to spray one spray in one nostril 30 minutes before meals and at bedtime, for 2 to 8 weeks. The most common side effect is a change in taste, but it can also make you feel sleepy or restless. There's a risk that it can cause movement-related side effects in newborns if taken by mothers during pregnancy.
What is Gimoti (metoclopramide)?
What is Gimoti (metoclopramide) used for?
Gastroparesis in adults who have diabetes
How Gimoti (metoclopramide) works
Gimoti (metoclopramide) is a dopamine antagonist. It works in your digestive system to promote movement and speed up digestion.
Drug Facts
What are the side effects of Gimoti (metoclopramide)?
Common Side Effects
- Change in taste (15%)
- Restlessness (10%)
- Drowsiness (10%)
- Tiredness (10%)
Other Side Effects
- Trouble sleeping
- Headache
- Confusion
- Dizziness
- Changes in mood
Serious Side Effects
- Uncontrolled muscle movements (tardive dyskinesia): sticking out your tongue, puffing out your cheeks, puckering your mouth, lip smacking, chewing, and shaking in your arms and legs
- Neuroleptic malignant syndrome (NMS): very high fever, stiff muscles, problem thinking clearly, very fast or uneven heartbeat, and sweating
- Suicidal thoughts and behavior
- Seizures
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- High fever, stiff muscles, increased sweating, fast or irregular heartbeat, and confusion, which may be signs of neuroleptic malignant syndrome
- High prolactin level—unexpected breast tissue growth, discharge from the nipple, change in sex drive or performance, irregular menstrual cycle
- Increase in blood pressure
- Swelling of the ankles, hands, or feet
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
- Uncontrolled and repetitive body movements, muscle stiffness or spasms, tremors or shaking, loss of balance or coordination, restlessness, shuffling walk, which may be signs of extrapyramidal symptoms (EPS)
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Change in taste
- Fatigue
- Headache
Pros and cons of Gimoti (metoclopramide)
Pros
Good option for people who don't like to take pills
Starts to work 30 minutes after a dose
Can be stored at room temperature
Cons
Might need to take up to 4 times a day
Not recommended for children or certain people with liver or kidney problems
Can cause movement-related side effects
Pharmacist tips for Gimoti (metoclopramide)
Gimoti (metoclopramide) works best if you take it at least 30 minutes before your meals (and again at bedtime). Timing Gimoti (metoclopramide) before your mealtime is important so it can help your body digest your food.
Gimoti (metoclopramide) isn't meant for long-term use because doing so can raise your risk of movement-related side effects. If you've been using it daily for 2 months or longer, talk to your prescriber to make sure they want you to continue using it.
Don't drive or do anything that needs a lot of focus or attention until you know how Gimoti (metoclopramide) affects you. This medication can make you feel drowsy and affect your ability to think clearly.
Tell your care team about all of the medications you're taking. Gimoti (metoclopramide) can interact with certain medications, which can affect how well they work or cause more side effects.
More tips on on how to use Gimoti (metoclopramide):
If you're using a new bottle of Gimoti (metoclopramide), first "prime" your bottle by pressing down and spraying 10 sprays of medication straight into the air. Priming your bottle ensures that you'll get the right amount of medication with your first dose.
If you haven't used your bottle of Gimoti (metoclopramide) for 2 weeks or longer, you'll need to prime it again before taking a dose.
After using Gimoti (metoclopramide), wipe the spray nozzle with a clean tissue.
If the Gimoti (metoclopramide) spray nozzle becomes clogged, you can remove it for cleaning. To do so, grab onto the spray nozzle and pull upward. To clear it, soak the spray nozzle in warm water and rinse. Afterward, let it dry at room temperature and put the nozzle back on the bottle.
Throw away your Gimoti (metoclopramide) bottle 4 weeks after you open it, even if the bottle still has medication in it.
Frequently asked questions about Gimoti (metoclopramide)
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What are the risks and warnings for Gimoti (metoclopramide)?
Gimoti (metoclopramide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Difficulty controlling movements
Risk factors: Taking metoclopramide for longer than 3 months | Taking other medications that cause TD | Older adults | Female and 65 years or older | Diabetes
Gimoti (metoclopramide) can cause tardive dyskinesia (TD), a side effect in which there is uncontrolled muscle movements in the tongue, face, mouth, lips, hands, arms, legs, and feet. To lower the risk of TD, you should avoid taking any form of metoclopramide for more than 3 months.
If you experience symptoms of TD, talk with your healthcare team right away because they'll ask you to stop taking Gimoti (metoclopramide). Symptoms of TD might go away after you stop taking this medication, but sometimes they can become permanent.
Your healthcare team won't prescribe Gimoti (metoclopramide) for you if you're already taking other medications that might also cause TD, such as prochlorperazine or haloperidol (Haldol).
Other conditions with uncontrolled muscle movements (dystonia, Parkinsonian symptoms, and restlessness)
Risk factors: People younger than 30 years old | Taking higher than recommended doses of Gimoti (metoclopramide) | Taking medications for Parkinson's disease | Taking antipsychotic medications
Gimoti (metoclopramide) can cause other uncontrolled muscle movements in addition to tardive dyskinesia (TD), such as repeated stiffening and twisting of muscles, tremors, jitteriness, pacing, and foot tapping. Symptoms are most commonly seen within the first 6 months and might occur as early as within the first 24 to 48 hours of taking Gimoti (metoclopramide). They typically go away after you stop the medication, but some might take 3 months or more to disappear completely. Stop taking the medication and get medical attention right away if you experience these symptoms.
Neuroleptic malignant syndrome (NMS)
Risk factors: Taking higher than recommended doses of Gimoti (metoclopramide) | Taking other medications that can cause NMS
Gimoti (metoclopramide) can cause neuroleptic malignant syndrome (NMS), which is a rare but life-threatening condition. Symptoms include a high fever, stiff muscles, problems thinking clearly, very fast or uneven heartbeat, and sweating. The risk is higher in people who are also taking antipsychotic medications. Stop taking Gimoti (metoclopramide) and get medical attention right away if you experience these symptoms. Your prescriber will let you know later if it's safe for you to restart this medication.
Depression and suicidal thoughts and behavior
Risk factors: Depression
People taking metoclopramide have reported depression. Talk to your prescriber if you notice any unusual changes in your mood. Get immediate medical help if you have suicidal thoughts or have desires to harm yourself.
High blood pressure
Risk factors: High blood pressure | Taking MAOI medications | Tumor on the kidney gland
Gimoti (metoclopramide) can raise your blood pressure and should be avoided in people with a history of high blood pressure or those taking medications called monoamine oxidase inhibitors (MAOIs). Gimoti (metoclopramide) shouldn't be used in people with pheochromocytoma tumor. Talk to your healthcare professional if you notice changes in your blood pressure.
Swelling in arms, legs, or around the belly
Risk factors: Liver damage | Heart failure
Gimoti (metoclopramide) can raise the level of aldosterone, a hormone that causes water to build up in your body. This leads to swelling in the arms, legs, or around the belly. People who have heart failure or liver problems are more at risk for this swelling. Let your prescriber know if you notice any swelling in your body or sudden weight gain.
High prolactin levels
Gimoti (metoclopramide) can cause prolactin hormone levels in your blood to go up. High prolactin levels can lead to symptoms such as milky substances being released from the nipple, enlarged breasts, and absent or irregular menstrual periods. Discuss with your prescriber if you experience or have any concerns about these symptoms.
Danger while driving
Taking Gimoti (metoclopramide) might make you feel sleepy and affect your ability to make decisions or thinking clearly. Your risk of these side effects is higher if you're drinking alcohol or taking other medications that can make you drowsy. Don't drive or do any activities that need a lot of focus or attention until you know how this medication makes you feel.
Gimoti (metoclopramide) dosage forms
Typical dosing for Gimoti (metoclopramide)
Each spray of Gimoti contains 15 mg of metoclopramide.
Adults younger than 65 years old: The typical dose is 1 spray in one nostril, 30 minutes before each meal and at bedtime (maximum of 4 sprays per day) for 2 to 8 weeks.
Adults ages 65 years and older: Older adults can be more sensitive to the side effects of Gimoti (metoclopramide). Your healthcare professional (HCP) will only prescribe this medication if you're already taking and are stable on another metoclopramide medication. They might start you on a lower dose of Gimoti (metoclopramide) to lower the risk of side effects.
The maximum duration of treatment with metoclopramide (all forms) is 3 months.
Gimoti (metoclopramide) contraindications
Past movement-related problems (like tardive dyskinesia) with metoclopramide
Tumor on adrenal glands (pheochromocytoma)
Seizures
Having other conditions where too much gut motility is dangerous (e.g., bleeding in the gut)
What are alternatives to Gimoti (metoclopramide)?
Delayed stomach-emptying caused by diabetes (diabetic gastroparesis)
Severe acid reflux (gastroesophageal reflux disease or GERD) when other medications haven’t worked
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References
Best studies we foundAl-Chalabi, M., et al. (2023). Physiology, prolactin. StatPearls.
Evoke Pharma, Inc. (2021). Gimoti- metoclopramide hydrochloride spray [package insert]. DailyMed.
McCallum, R. W., et al. (2024). Metoclopramide nasal spray in women with symptomatic diabetic gastroparesis: A randomized, double-blind, placebo-controlled phase 3 study. Clinical Gastroenterology and Hepatology.
MedlinePlus. (2024). Pheochromocytoma.
MotherToBaby. (2021). Metoclopramide.
National Cancer Institute. (2020). Pheochromocytoma.
You and Your Hormones. (2021). Aldosterone.
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