Bolus and infusions of metoclopramide: insights on benefits and risks from pharmacokinetic modelling.

Use loading doses of 0.05-0.1 mg/kg with metoclopramide CRI to avoid 3.25-hour therapeutic delay.

Metoclopramide is commonly used in canine practice for emesis prevention and gastroesophageal reflux treatment. Traditional dosing involves three to four daily administrations, but constant rate infusions (CRI) have become increasingly popular, delivering 1-2 mg/kg/day. However, concerns about adverse reactions from intravenous boluses and delayed onset when loading doses are omitted necessitate optimized dosing strategies. This pharmacokinetic modeling study reanalyzed existing canine metoclopramide data to determine optimal loading dose protocols for CRI administration. The research demonstrates that omitting a loading dose results in a 3.25-hour delay to reach steady-state plasma concentrations. The authors recommend loading doses of 0.05 mg/kg for 1 mg/kg/day infusions and 0.1 mg/kg for 2 mg/kg/day infusions to achieve target plasma levels promptly without excessive peak concentrations. These evidence-based loading dose recommendations enable clinicians to achieve therapeutic efficacy immediately while maintaining safer plasma concentration profiles compared to traditional bolus dosing, improving both safety and clinical outcomes in canine patients requiring metoclopramide therapy.

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