10 Metoclopramide (Reglan) Side Effects and How to Manage Them

Metoclopramide (Reglan, Gimoti) has been around for decades. It’s the only medication approved to treat diabetic gastroparesis (slowed emptying of the stomach). It may be an option if other gastroesophageal reflux disease treatments haven’t worked. But healthcare providers recommend taking metoclopramide for only a short time. Why?

Along with typical side effects such as drowsiness and fatigue, metoclopramide can cause movement problems in some people. This is uncommon, but the risk goes up the longer you take it. So it’s a good idea to familiarize yourself with the potential side effects and risks of treatment.

Metoclopramide side effects at a glance

Metoclopramide comes in a few forms: oral tablets, an oral solution, an injection, and a nasal spray. You typically take metoclopramide as needed or on a regular schedule, depending on what you’re using it for.

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Like all medications, metoclopramide can cause side effects. And the likelihood of experiencing them may vary depending on your dosage form, dose, and frequency.

Common metoclopramide side effects include:

• Restlessness

• Drowsiness

• Fatigue

• Insomnia

• Dizziness

• Nervousness

• Headache

• Confusion

Less common but potentially serious metoclopramide side effects include:

• Tardive dyskinesia and other movement problems

• Neuroleptic malignant syndrome

• Depression

• High or low blood pressure

• Fluid buildup

• Hyperprolactinemia (hormonal effects)

• Seizures in people with epilepsy

• Hallucinations

Be sure to check with your healthcare provider about managing your specific side effects. Below, we’ll describe 10 metoclopramide side effects you could experience.

1. Restlessness

Feelings of restlessness can happen when you take metoclopramide. About 1 in 10 people who take the medication may experience this side effect.

If your symptoms are mild, you may be able to manage them at home. They may even go away on their own. But if your symptoms are bothersome, talk to your healthcare provider. They may recommend lowering your dose or switching to a different medication. 

Pronounced and persistent symptoms, such as the inability to sit still, could mean you have a more severe form of restlessness called akathisia. In this case, contact your healthcare provider right away. They’ll likely have you stop taking metoclopramide.

2. Drowsiness

Some people taking metoclopramide report feeling sleepy or drowsy. Keep in mind that metoclopramide is often taken many times a day. It’s a good idea to see how it affects you before driving or performing other tasks that need you to be alert.

You may be able to adjust when you take metoclopramide so the drowsiness doesn’t affect your daily activities as much. But if your drowsiness is becoming a problem, talk with your healthcare provider. They can suggest the best next steps.

Good to know: Taking metoclopramide with other medications and substances (such as alcohol) that cause drowsiness can worsen this side effect. Share your medication list with your healthcare team to identify potential interactions.

3. Fatigue

Fatigue is another common metoclopramide side effect. You might feel weak or low on energy. For some people, this may make it difficult to take care of your daily responsibilities.

If you’re feeling extra tired, weak, or fatigued after taking metoclopramide, ask your healthcare provider how you can relieve those symptoms. Things you can try at home to boost your energy include getting plenty of rest, exercising, and eating healthy, nutrient-rich foods.

4. Dizziness

Some people report dizziness, especially after stopping metoclopramide. Keep in mind that there are many possible causes of dizziness. If you’re living with diabetes, for example, dizziness can also be a symptom of low blood glucose (sugar).

If you’re feeling dizzy after stopping metoclopramide, sit or lie down until it passes to prevent falling down. Also, avoid activities like driving if you feel dizzy. If you have diabetes, check your blood glucose levels to make sure they’re not too low.

Feelings of dizziness should improve within a few days. If your dizziness is severe or not going away, tell  your healthcare provider.

5. Headache

Headache is another possible metoclopramide side effect. Like dizziness, headaches are more likely to happen after you stop taking metoclopramide. And they may be more pronounced if you were taking it regularly for a few weeks or more. Similarly, headaches may be less likely if you were taking metoclopramide occasionally for a short time.

The headaches should start to improve within a few days. But if they’re hard to tolerate, your healthcare provider may suggest an over-the-counter pain reliever. It’s also a good idea to stay hydrated and get plenty of sleep.

6. Trouble sleeping

Metoclopramide can make you feel sleepy, but it can also cause trouble sleeping. This side effect may be related to restlessness, which can make it more difficult to fall or stay asleep. What’s more, metoclopramide can worsen symptoms of restless legs syndrome, which can also disrupt your sleep.

If you’re having trouble sleeping while taking metoclopramide, there are a few things you can try. Make sure you have good sleep hygiene by creating an environment that will help you go to sleep. Try to avoid excessive naps during the day and electronic screens right before bed.

If you’re still having difficulty sleeping, tell your healthcare provider. They may suggest lowering your metoclopramide dose or switching medications.

7. Depression

Depression is another possible metoclopramide side effect. It can happen in anyone taking metoclopramide, including those without a history of depression. To be safe, it’s recommended to avoid metoclopramide if you have a history of depression.

Depression symptoms are personal and vary. They include feelings of sadness or hopelessness, changes in your appetite, and a lack of interest in daily activities. In rare cases, thoughts of suicide are also possible. If you notice changes in your mood or behaviors while taking metoclopramide, contact your healthcare provider right away.

If you or someone you know is experiencing thoughts of suicide or a mental health crisis, help is available. Call or text the 988 Suicide & Crisis Lifeline by dialing 988. This number connects you with free and confidential professional assistance.

8. Hormonal effects

Metoclopramide can also cause certain hormonal effects. Specifically, it can cause high prolactin levels (called hyperprolactinemia). In women, symptoms include menstrual changes, breast discharge (milk production), and mood changes. For men, symptoms of decreased libido and erectile dysfunction are possible.

If you notice these effects or other abnormal hormonal changes, tell your healthcare provider. If metoclopramide is causing your symptoms, they may change your dose or switch your medications. Depending on the severity of your symptoms, you could need a treatment that lowers prolactin levels.

9. Tardive dyskinesia and other movement problems

Tardive dyskinesia (TD) is a movement disorder that causes uncontrollable movements of the face and tongue, upper trunk, and arms. This is a serious metoclopramide side effect, and it may not be reversible if it happens. Metoclopramide has a boxed warning, the FDA’s strongest warning, for TD.

Older adults may be more likely to develop this side effect. It’s also more likely if you’re taking metoclopramide for a long time (more than 12 weeks) and at high doses. If you notice these irregular movements, let your healthcare provider know right away. They will likely tell you to stop taking metoclopramide.

10. Neuroleptic malignant syndrome

While rare, neuroleptic malignant syndrome (NMS) is another serious side effect that’s possible from taking metoclopramide. NMS is more likely with higher metoclopramide doses and if you take metoclopramide with other medications that have an NMS risk, such as antipsychotics.

NMS symptoms include fever, rigid muscles, and confusion. You can also have changes in your heart rate, blood pressure, and breathing. NMS is life-threatening, so seek emergency medical care if you develop symptoms.

When should you contact your healthcare provider about metoclopramide side effects?

Contact your healthcare provider if you’re concerned about any metoclopramide side effects. This is especially important if you notice any movement problems, since they can become permanent. Your provider can also help you manage other side effects that are bothersome or interfering with your daily activities.

Certain metoclopramide side effects, such as NMS, require emergency medical care. Have someone take you to the nearest ER if you have symptoms such as fever, rigid muscles, and confusion.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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