Vet’s 2025 Guide to Metoclopramide in Horses – by Dr Duncan Houston
In this article
💊 Vet’s 2025 Guide to Metoclopramide in Horses
By Dr Duncan Houston BVSc
1. What Is Metoclopramide?
Metoclopramide is a **prokinetic and antiemetic medication** that enhances upper gastrointestinal motility by blocking dopamine D₂ receptors and stimulating serotonin 5‑HT₄ receptors—aiding gastric emptying and acting centrally to reduce nausea.
2. Why Use It in Horses?
It’s primarily used in equines to:
- Manage **post‑operative ileus**—common after colic surgery (^10^)
- Treat **esophageal reflux or gastric stasis**, particularly in foals following neonatal hypoxia (^1^)
- Support recovery from gastric motility disorders
3. Recommended Dosage
According to the Merck Veterinary Manual:
- **IV infusion**: 0.125–0.25 mg/kg in 500 mL polyionic fluid over 60 minutes; or continuous infusion at **0.04 mg/kg/hour** (^6^)
For foals, **IV administration** is commonly chosen in hospital settings (^1^).
4. Administration Tips
- **IV infusion only**—never IM or oral in adult horses due to erratic activity (^3^)
- Dilute in compatible fluids and administer slowly over an hour to reduce side effects (^6^)
- Compatible with other motility-enhancing measures like **lidocaine CRI** (^20^)
5. Potential Side Effects
Side effects are primarily neurological:
- **Sedation**, **excitement**, **restlessness**, sweating—especially with high IV doses (0.02–0.25 mg/kg/h) (^15^,^9^)
- Extrapyramidal signs including **dystonia**, rare but reported, especially after SC injection (^5^,^13^)
- Abdominal discomfort and altered GI signs—more likely with bolus dosing (^3^,^15^)
6. Monitoring Strategies
- Watch behavioral changes—excitability or dullness
- Assess gut sounds, reflux volume, and manure output regularly
- Adjust infusion rate or discontinue if severe neurological signs occur
7. Contraindications & Cautions
- Avoid in **mechanical GI obstruction** as increased motility may worsen perforation (^10^)
- Caution with **neurological disease or seizure history** due to pro-dopaminergic central effects
- Use cautiously in **foals**—metabolic drug clearance differs
8. Combining with Other GI Therapies
Often used with other prokinetics:
- **Lidocaine CRI**—benefits from both motility and anti-inflammatory effects (^20^)
- **Erythromycin IV**—another prokinetic option (^6^)
9. Evidence & Clinical Outcomes
Though side effects limit long-term use in adults, metoclopramide IV/CRI can significantly reduce postoperative reflux and shorten hospitalization after colic surgery (^20^,^10^).
10. Ask A Vet Support 🩺
With Ask A Vet, you’ll have assistance with:
- Selecting appropriate dosage and infusion protocols
- Recognizing and managing side effects early
- Monitoring gut function, reflux volumes, and behavior
- Combining therapy protocols for motility disorders
- Planning taper strategies and emergency response
Download the Ask A Vet app today for real‑time guidance and peace‑of‑mind support during GI recovery in 2025! ❤️
11. Quick Reference Table
| Aspect | Key Points |
|---|---|
| Use | Post‑op ileus, reflux, neonatal GI stasis (foals) |
| Dosage | 0.125–0.25 mg/kg IV over 60 min or 0.04 mg/kg/h CRI |
| Administration | Diluted in fluids, slow infusion |
| Side Effects | Sedation, excitability, sweating, dystonia |
| Contraindications | No mechanical obstruction, caution with neuro disease |
| Monitoring | Behavior, GI motility, reflux, hydration |
12. Final Thoughts
Metoclopramide is a powerful prokinetic in equine veterinary medicine when used carefully via IV infusion. Proper dosing, side‑effect awareness, and supportive protocols underpin its effective use in postoperative ileus and reflux. With Ask A Vet’s expert oversight, owners can confidently navigate gastrointestinal recovery and support their horse’s comfort and healing in 2025 and beyond. 🐴💊
