Primperan
Metoclopramide Injection for Nausea and Vomiting
Quick Facts About Primperan
Key Takeaways About Primperan
- Short-term use only: Treatment must not exceed 3 months due to the risk of tardive dyskinesia, a potentially irreversible movement disorder
- Administered by healthcare professionals: Primperan injection is given intravenously (over at least 3 minutes) or intramuscularly in a clinical setting
- Maximum 30 mg per day: The recommended adult dose is 10 mg up to three times daily, with at least 6 hours between each dose
- Use with caution in children: Extrapyramidal reactions are more common in children and young adults; contraindicated in children under 1 year
- Multiple drug interactions: Metoclopramide must not be combined with levodopa or dopamine agonists, and caution is needed with sedatives, opioids, and antipsychotics
What Is Primperan and What Is It Used For?
Primperan (metoclopramide) is an antiemetic medication that prevents and treats nausea and vomiting. It works by blocking dopamine receptors in the chemoreceptor trigger zone of the brain and by stimulating upper gastrointestinal motility, accelerating gastric emptying and intestinal transit.
Metoclopramide, the active substance in Primperan, belongs to the class of substituted benzamides and has a dual mechanism of action. As a dopamine D2 receptor antagonist, it acts centrally on the chemoreceptor trigger zone (CTZ) in the area postrema of the brain, which is the primary region responsible for initiating the vomiting reflex. By blocking dopamine signals in this area, metoclopramide effectively suppresses the sensation of nausea and the urge to vomit.
In addition to its central antiemetic action, metoclopramide has important peripheral prokinetic effects. It enhances gastric motility by acting as a 5-HT4 (serotonin) receptor agonist and by facilitating acetylcholine release from enteric neurons. This dual peripheral action accelerates gastric emptying, increases lower oesophageal sphincter tone, and promotes coordinated peristalsis in the upper gastrointestinal tract. These prokinetic properties make metoclopramide particularly useful in clinical situations where delayed gastric emptying contributes to nausea, such as post-operative ileus or diabetic gastroparesis.
Primperan injection is specifically indicated for the following conditions in adults:
- Prevention of post-operative nausea and vomiting (PONV): A single dose of 10 mg is given before or during surgery to prevent nausea and vomiting during the recovery period
- Treatment of established nausea and vomiting, including nausea and vomiting associated with acute migraine attacks, where it also helps improve the absorption of oral analgesics that may otherwise be poorly absorbed due to gastric stasis
- Prevention of radiation-induced nausea and vomiting: Administered before radiotherapy sessions to reduce the incidence and severity of nausea
In children and adolescents aged 1 to 18 years, Primperan is used only as a second-line treatment when other therapies have been ineffective or are unavailable:
- Prevention of delayed chemotherapy-induced nausea and vomiting (CINV): Used alongside other antiemetics in combination regimens
- Treatment of established post-operative nausea and vomiting: When first-line treatments have not provided adequate relief
Metoclopramide was first synthesised in 1964 and has been in clinical use for over 60 years. It is listed on the World Health Organization’s Model List of Essential Medicines, reflecting its importance in global healthcare. In 2013, the European Medicines Agency (EMA) conducted a comprehensive review of metoclopramide and introduced restrictions on its use, including a maximum treatment duration of 5 days for oral/injectable forms and specific dose limitations, to minimise the risk of neurological side effects.
What Should You Know Before Taking Primperan?
Before receiving Primperan, your doctor must be informed about all your medical conditions and medications. Metoclopramide is contraindicated in several conditions including gastrointestinal bleeding, phaeochromocytoma, epilepsy, and Parkinson’s disease. Treatment duration must be kept as short as possible due to the risk of tardive dyskinesia.
Contraindications
You must not receive Primperan if any of the following apply to you:
- Allergy to metoclopramide or any other ingredient in the medicine (including sodium chloride in the injection formulation)
- Gastrointestinal bleeding, obstruction, or perforation – metoclopramide stimulates gastrointestinal motility, which could worsen these conditions and make the situation potentially life-threatening
- Confirmed or suspected phaeochromocytoma – a rare adrenal gland tumour that could cause a dangerous hypertensive crisis if stimulated by metoclopramide
- History of tardive dyskinesia from previous treatment with metoclopramide or other dopamine receptor-blocking agents – re-exposure could cause irreversible involuntary movements
- Epilepsy – metoclopramide may increase the frequency and severity of seizures
- Parkinson’s disease – as a dopamine antagonist, metoclopramide would directly worsen parkinsonian symptoms
- Concurrent use of levodopa or dopamine agonists – metoclopramide directly opposes the pharmacological effect of these medications
- History of methaemoglobinaemia or NADH cytochrome-b5 reductase deficiency – metoclopramide can induce methaemoglobinaemia in susceptible individuals
- Children under 1 year of age – due to the significantly increased risk of extrapyramidal reactions in this population
Warnings and Precautions
Talk to your doctor, pharmacist, or nurse before receiving Primperan if you have or have had any of the following:
- Abnormal heart rhythm (QT prolongation) or other cardiac problems – metoclopramide can cause QT interval prolongation, which may lead to serious cardiac arrhythmias
- Electrolyte imbalances (abnormal levels of potassium, sodium, or magnesium in the blood) – these increase the risk of cardiac arrhythmias when combined with metoclopramide
- Neurological conditions affecting nerves or muscles – metoclopramide may exacerbate symptoms
- Kidney or liver problems – the dose may need to be reduced because metoclopramide is primarily eliminated through the kidneys and metabolised in the liver
- Taking other medicines that affect heart rhythm – combined use increases the risk of QT prolongation
Your doctor may need to perform blood tests to check your pigment levels (methaemoglobin). If abnormal levels are detected, treatment must be stopped immediately and permanently.
Do not exceed 3 months of treatment due to the risk of tardive dyskinesia – involuntary, repetitive movements of the face, tongue, or other body parts that may become permanent. The risk increases with prolonged treatment and higher cumulative doses. Elderly patients, particularly older women, are at highest risk. If signs of tardive dyskinesia appear, treatment must be discontinued immediately.
Use in Children and Adolescents
Involuntary movements (extrapyramidal disorders) are more common in children and young adults receiving metoclopramide compared to older adults. These reactions typically occur within 24–72 hours of starting treatment and may include muscle spasms in the neck and face (torticollis and trismus), abnormal eye movements (oculogyric crisis), and tongue protrusion. Primperan must not be given to children under 1 year of age because the risk of extrapyramidal reactions is unacceptably high in this age group.
In children aged 1 to 18 years, Primperan should only be used as a second-line treatment when other antiemetic options have failed or are not available. The dose must be carefully calculated based on body weight, and treatment duration should be limited to 48 hours for post-operative nausea and vomiting and 5 days for delayed chemotherapy-induced nausea and vomiting.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to become pregnant, tell your doctor before receiving Primperan. A large body of clinical data from more than 1,000 exposed pregnancies indicates no evidence of malformative or foetotoxic effects. Primperan may be used during pregnancy if clinically necessary, as determined by your healthcare provider. Your doctor will carefully weigh the benefits against any potential risks.
Metoclopramide passes into breast milk and may affect a nursing infant. Primperan is not recommended during breastfeeding. If treatment is considered essential, your doctor may advise you to discontinue breastfeeding during the treatment period and for at least 24 hours after the last dose to allow the drug to be eliminated from your system.
Driving and Operating Machinery
Metoclopramide can cause drowsiness, dizziness, and extrapyramidal disorders such as involuntary movements and abnormal muscle tension. These effects can significantly impair your ability to drive or operate machinery. You should not drive or use machines until you are sure that Primperan does not affect your alertness or coordination. This is particularly important after the first dose and any dose increases, as side effects are more likely during these periods.
How Does Primperan Interact with Other Drugs?
Metoclopramide interacts with numerous medications, including dopaminergic agents, sedatives, opioids, antipsychotics, and drugs that affect heart rhythm. Some combinations are absolutely contraindicated, while others require careful monitoring or dose adjustment. Always inform your healthcare provider about all medications you are taking.
Because metoclopramide acts primarily as a dopamine D2 receptor antagonist, it has pharmacodynamic interactions with any medication that affects dopamine signalling. Additionally, its prokinetic effects can alter the absorption of orally administered medications by changing gastric transit time. The following tables detail the most clinically significant drug interactions.
Contraindicated Combinations
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Levodopa | Anti-parkinsonian | Mutual antagonism – metoclopramide blocks dopamine receptors that levodopa aims to stimulate | Absolutely contraindicated; do not combine |
| Dopamine agonists (pramipexole, ropinirole, etc.) | Anti-parkinsonian | Mutual antagonism – reduced efficacy of both drugs | Absolutely contraindicated; do not combine |
Major Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Antipsychotics (haloperidol, chlorpromazine, etc.) | Neuroleptics | Additive risk of extrapyramidal disorders, neuroleptic malignant syndrome, and QT prolongation | Avoid combination; if essential, use lowest doses with close monitoring |
| Morphine derivatives (codeine, tramadol, fentanyl, etc.) | Opioid analgesics | Enhanced sedation; both drugs slow CNS activity. Opioids also slow gastric emptying, opposing metoclopramide’s prokinetic effect | Use with caution; monitor for excessive sedation and respiratory depression |
| SSRIs (fluoxetine, paroxetine, etc.) | Antidepressants | Increased risk of serotonin syndrome and extrapyramidal reactions | Use with caution; monitor for signs of serotonin toxicity |
| Suxamethonium / Mivacurium | Neuromuscular blockers | Metoclopramide may prolong the neuromuscular blocking effect | Anaesthetist should be aware; monitor neuromuscular function closely |
Moderate Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Anticholinergics (atropine, hyoscine, etc.) | Antispasmodics | Antagonism of metoclopramide’s prokinetic effect on the gastrointestinal tract | Avoid concurrent use where possible; effects may cancel each other out |
| Digoxin | Cardiac glycoside | Metoclopramide may reduce digoxin absorption by accelerating gastric transit | Monitor digoxin levels; dose adjustment may be needed |
| Cyclosporine | Immunosuppressant | Increased cyclosporine bioavailability due to accelerated gastric emptying | Monitor cyclosporine blood levels; dose reduction may be necessary |
| Rifampicin | Antibiotic (TB treatment) | Enzyme induction may reduce metoclopramide blood levels | Monitor antiemetic efficacy; dose increase may be needed |
| Atovaquone | Anti-infective (malaria/pneumonia) | Metoclopramide may reduce atovaquone plasma levels | Avoid concurrent use if possible; monitor therapeutic response |
| Sedatives & antihistamines | CNS depressants | Additive sedation and drowsiness | Use with caution; warn patients about increased drowsiness |
Alcohol Interaction
Alcohol must not be consumed during treatment with metoclopramide. Alcohol is a central nervous system depressant that enhances the sedative effects of metoclopramide, leading to increased drowsiness, impaired coordination, and reduced alertness. This combination significantly increases the risk of falls and accidents, particularly in elderly patients. If you consume alcohol regularly, inform your doctor before starting treatment with Primperan.
Primperan injection contains less than 1 mmol (23 mg) sodium per ampoule, meaning it is essentially sodium-free. This is generally not a concern, but patients on a very strict sodium-restricted diet should be made aware.
What Is the Correct Dosage of Primperan?
Primperan injection is administered by a healthcare professional as a slow intravenous injection (over at least 3 minutes) or as an intramuscular injection. The standard adult dose is 10 mg up to three times daily, with a minimum interval of 6 hours between doses and a maximum daily dose of 30 mg.
Primperan is normally given in a hospital or clinical setting by a doctor or nurse. Because it is an injectable formulation, the dose is carefully measured and administered under medical supervision. The route of administration, timing, and total daily dose depend on the clinical indication, patient age, body weight, and organ function.
Adults
Post-operative Nausea and Vomiting (Prevention)
A single dose of 10 mg administered by slow intravenous injection at the time of surgery or during the recovery period.
Nausea and Vomiting (Including Migraine-Associated)
The recommended single dose is 10 mg, which may be repeated up to 3 times daily. There must be at least 6 hours between each dose. The maximum recommended daily dose is 30 mg or 0.5 mg/kg body weight, whichever is lower.
Radiation-Induced Nausea and Vomiting (Prevention)
The recommended single dose is 10 mg, administered before radiotherapy. May be repeated up to 3 times daily with at least 6 hours between doses.
Children and Adolescents (1–18 Years)
The recommended dose in children is 0.1 to 0.15 mg/kg body weight, given as a slow intravenous injection. This dose may be repeated up to three times per day. The maximum total daily dose is 0.5 mg/kg body weight.
| Age | Body Weight | Dose per Administration | Frequency |
|---|---|---|---|
| 1–3 years | 10–14 kg | 1 mg | Up to 3 times daily |
| 3–5 years | 15–19 kg | 2 mg | Up to 3 times daily |
| 5–9 years | 20–29 kg | 2.5 mg | Up to 3 times daily |
| 9–18 years | 30–60 kg | 5 mg | Up to 3 times daily |
| 15–18 years | Over 60 kg | 10 mg | Up to 3 times daily |
Duration of treatment in children: Treatment must not exceed 48 hours for post-operative nausea and vomiting, and 5 days for prevention of delayed chemotherapy-induced nausea and vomiting.
Elderly Patients
Elderly patients may require dose reduction depending on kidney function, liver function, and overall clinical condition. The elderly are at increased risk for side effects, particularly tardive dyskinesia and extrapyramidal reactions. Your doctor will start with the lowest effective dose and may reduce the frequency of administration. Close monitoring is essential throughout the treatment period.
Patients with Kidney Problems
If you have moderate or severe kidney impairment, the dose of Primperan must be reduced. Because approximately 85% of metoclopramide is excreted by the kidneys, impaired renal function leads to prolonged drug exposure and an increased risk of side effects. Your doctor will calculate an appropriate reduced dose based on your creatinine clearance or estimated glomerular filtration rate (eGFR).
Patients with Liver Problems
If you have severe liver impairment, the dose of Primperan should be reduced. The liver is the primary site of metoclopramide metabolism, and reduced hepatic function can lead to higher plasma concentrations of the drug. Your doctor will determine the appropriate dose reduction based on your clinical condition and liver function tests.
Overdose
As Primperan injection is administered by healthcare professionals in a clinical setting, overdose is unlikely. However, if it occurs, symptoms may include:
- Extrapyramidal disorders – involuntary movements, muscle spasms, abnormal posturing
- Excessive drowsiness and reduced consciousness
- Confusion and hallucinations
- Cardiac problems – arrhythmias, QT prolongation, bradycardia
Treatment of overdose is symptomatic and supportive. Extrapyramidal reactions are typically treated with anticholinergic agents (such as biperiden) or benzodiazepines. Cardiac monitoring should be continued until the drug is eliminated. There is no specific antidote for metoclopramide overdose.
What Are the Side Effects of Primperan?
Like all medicines, Primperan can cause side effects, although not everybody gets them. The most common side effect is drowsiness. Serious but less common effects include extrapyramidal disorders (involuntary movements), neuroleptic malignant syndrome, and cardiac arrhythmias. Seek immediate medical attention if you experience involuntary movements, high fever with muscle rigidity, or signs of a severe allergic reaction.
The side effects of metoclopramide are largely related to its dopamine-blocking activity in the central nervous system. Neurological side effects, particularly extrapyramidal reactions, are the most clinically significant concern and are the primary reason for restricting treatment duration to a maximum of 3 months. The risk of these effects is higher in children, young adults, elderly patients, and those receiving high doses.
Involuntary movements or muscle contractions (especially of the head, neck, face, or tongue); high fever combined with muscle rigidity, sweating, and altered consciousness (possible neuroleptic malignant syndrome); skin rash with itching, difficulty breathing, swelling of the face, lips, or throat, cold sweats, rapid heartbeat, or fainting (signs of a severe allergic reaction).
Very Common
May affect more than 1 in 10 people
- Drowsiness and increased need for sleep (somnolence)
Common
May affect up to 1 in 10 people
- Depression
- Involuntary movements including tics, tremor, twisting movements or muscle contractions (dystonia, rigidity)
- Parkinson-like symptoms (stiffness, tremor, slow movement)
- Restlessness (akathisia)
- Low blood pressure (especially with intravenous administration)
- Diarrhoea
- Feeling of weakness (asthenia)
Uncommon
May affect up to 1 in 100 people
- Elevated prolactin levels, which may cause: breast milk production in men and non-lactating women, irregular menstrual periods
- Hallucinations
- Reduced level of consciousness
- Slow heart rate (bradycardia), especially with intravenous administration
- Allergic reactions
- Dry mouth
- Skin rash
- Visual disturbances and involuntary eye movements
Rare
May affect up to 1 in 1,000 people
- Confusional state
- Seizures (particularly in patients with epilepsy)
- High blood pressure (hypertension)
- Urticaria (hives)
Not Known
Frequency cannot be estimated from available data
- Severe allergic reactions (anaphylaxis, angioedema) – seek emergency care immediately
- Methaemoglobinaemia – abnormal blood pigment levels that may change skin colour
- Gynaecomastia (abnormal breast development in males)
- Tardive dyskinesia – involuntary muscle spasms after prolonged use, especially in the elderly
- Neuroleptic malignant syndrome – high fever, high blood pressure, seizures, sweating, excessive salivation
- Cardiac rhythm disturbances (QT prolongation visible on ECG)
- Cardiac arrest (especially with injection)
- Shock – severe drop in blood pressure (especially with injection)
- Syncope (fainting), especially with intravenous administration
- Very high blood pressure (hypertensive crisis)
- Suicidal thoughts
If you experience any side effects, whether listed above or not, tell your doctor, pharmacist, or nurse. You can also report suspected side effects through your national pharmacovigilance system. Reporting helps regulatory authorities continuously monitor the benefit-risk balance of medicines.
How Should You Store Primperan?
Primperan injection should be kept out of the sight and reach of children. Do not use after the expiry date printed on the ampoule label and outer carton. As a hospital-administered medicine, storage is typically handled by the pharmacy or clinical department.
Because Primperan injection is a hospital and clinical medicine, you will not usually need to store it at home. However, the following storage information may be useful for healthcare professionals and pharmacists:
- Keep out of the sight and reach of children at all times
- Check the expiry date before each use – the expiry date refers to the last day of the month indicated
- Store in the original packaging to protect from light
- Do not use if the solution appears discoloured, cloudy, or contains visible particles
- Single-use ampoules – any unused solution should be discarded immediately after opening. Do not store opened ampoules for later use
Do not dispose of medicines through household waste or wastewater. Ask your pharmacist how to properly dispose of medicines you no longer use. These measures help protect the environment and reduce the risk of accidental exposure.
What Does Primperan Contain?
Each Primperan ampoule contains metoclopramide hydrochloride as the active substance (equivalent to 5 mg/ml metoclopramide), sodium chloride as an excipient, and water for injections as the solvent.
Primperan solution for injection has a simple formulation designed for parenteral administration:
Active Substance
Metoclopramide hydrochloride – equivalent to 5 mg metoclopramide per ml. Each 2 ml ampoule contains 10 mg of metoclopramide.
Excipients
Sodium chloride (7.5 mg per ampoule) – used as an isotonicity agent to ensure the injection is compatible with body fluids. Water for injections – the sterile solvent.
Packaging
Each pack contains 12 glass ampoules, each holding 2 ml of solution. The solution is clear and colourless.
The marketing authorisation holder for Primperan is Sanofi, a global pharmaceutical company. Metoclopramide is also available under numerous other brand names and as generic formulations worldwide, providing widespread access to this essential antiemetic medication.
Frequently Asked Questions About Primperan
Primperan (metoclopramide) injection is used to prevent and treat nausea and vomiting in adults. Its specific indications include prevention of post-operative nausea and vomiting, treatment of nausea and vomiting (including migraine-associated), and prevention of radiation-induced nausea and vomiting. In children aged 1–18 years, it is used as a second-line treatment for delayed chemotherapy-induced nausea and vomiting and established post-operative nausea and vomiting. It works by blocking dopamine receptors in the brain and by accelerating gastric emptying.
Treatment with Primperan must not exceed 3 months in adults because of the risk of tardive dyskinesia, a potentially permanent movement disorder involving involuntary repetitive movements of the face and tongue. In practice, most indications require much shorter treatment: a single dose for post-operative prevention, and short courses (days) for other indications. In children, treatment should not exceed 48 hours for post-operative nausea and 5 days for chemotherapy-related nausea. Always follow your doctor’s instructions regarding treatment duration.
The most serious risks include tardive dyskinesia (potentially irreversible involuntary movements after prolonged use), neuroleptic malignant syndrome (a rare but life-threatening reaction characterised by high fever, muscle rigidity, and altered consciousness), severe allergic reactions including anaphylaxis, cardiac arrhythmias (QT prolongation), and cardiac arrest (particularly with intravenous injection). Extrapyramidal reactions such as acute dystonia, akathisia, and parkinsonism are also significant concerns, especially in children and young adults. These risks are why metoclopramide use is time-limited and carefully monitored.
Primperan may be used during pregnancy if your doctor determines it is clinically necessary. A large amount of clinical data from more than 1,000 exposed pregnancies has shown no evidence of birth defects or harm to the developing baby. However, as with all medicines during pregnancy, the benefits must outweigh the potential risks. It is not recommended during breastfeeding because metoclopramide passes into breast milk and could affect the infant. Always discuss your options with your healthcare provider.
Primperan injection is given by a healthcare professional, either as a slow intravenous injection over at least 3 minutes (into a vein) or as an intramuscular injection (into a muscle). The slow intravenous administration is important to reduce the risk of acute side effects. The standard adult dose is 10 mg (one 2 ml ampoule), which can be given up to three times daily with at least 6 hours between doses. It is not intended for self-administration at home.
Primperan injection (intravenous or intramuscular) delivers metoclopramide directly into the bloodstream, providing a faster onset of action compared to oral formulations. This makes the injection particularly useful in situations where patients are actively vomiting and unable to keep oral medication down, or in perioperative settings where rapid antiemetic effect is needed. The active substance and maximum daily dose (30 mg for adults) are the same for both routes. The injection form is typically used in hospital or clinical settings, while oral forms (tablets, syrup) are used for outpatient management.
References
- European Medicines Agency (EMA). “Metoclopramide-containing medicines.” EMA/443003/2013. European Medicines Agency, 2013. Referral assessment report on the benefit-risk balance of metoclopramide-containing medicines.
- World Health Organization. “WHO Model List of Essential Medicines – 23rd List, 2023.” Geneva: World Health Organization, 2023.
- Rao AS, Camilleri M. “Review article: metoclopramide and tardive dyskinesia.” Alimentary Pharmacology & Therapeutics. 2010;31(1):11–19.
- Pasricha PJ, Pehlivanov N, Suber JR, et al. “Drug insight: from disturbed motility to disordered movement – a review of the clinical benefits and medicolegal risks of metoclopramide.” Nature Clinical Practice Gastroenterology & Hepatology. 2006;3(3):138–148.
- National Institute for Health and Care Excellence (NICE). “Metoclopramide hydrochloride.” British National Formulary (BNF). Accessed January 2026.
- Sanofi. “Primperan Summary of Product Characteristics (SmPC).” Last updated March 2023.
- Gan TJ, Belani KG, Bergese S, et al. “Fourth consensus guidelines for the management of postoperative nausea and vomiting.” Anesthesia & Analgesia. 2020;131(2):411–448.
- Hesketh PJ, Kris MG, Basch E, et al. “Antiemetics: ASCO Guideline Update.” Journal of Clinical Oncology. 2020;38(24):2782–2797.
- U.S. Food and Drug Administration (FDA). “Metoclopramide: Drug Safety Communication – Risk of neurological side effects.” FDA Drug Safety Communication, 2009.
- Albibi R, McCallum RW. “Metoclopramide: pharmacology and clinical application.” Annals of Internal Medicine. 1983;98(1):86–95.
About This Article
Written By
iMedic Medical Editorial Team
Specialists in gastroenterology, clinical pharmacology, and internal medicine with extensive experience in evidence-based medical writing.
Medically Reviewed By
iMedic Medical Review Board
Independent panel of board-certified physicians who review all content according to WHO, EMA, FDA, and NICE guidelines using the GRADE evidence framework.
This article is based on the approved Summary of Product Characteristics (SmPC) for Primperan, peer-reviewed pharmacological literature, and international clinical guidelines. All information has been independently verified and adapted for an international audience. The content is updated regularly to reflect the latest evidence and regulatory guidance.