Metoclopramide modelling study sharpens bolus-versus-CRI decisions

A new Journal of Small Animal Practice paper reanalyzes pharmacokinetic data from dogs given metoclopramide and models how the drug behaves during constant-rate infusion, with and without a loading dose. The study’s core finding is practical: if clinicians want target plasma concentrations immediately, a front-end bolus may be needed rather than starting a constant infusion alone and waiting for concentrations to build. The paper was published May 25, 2026, and comes from M. Martin-Flores, A. M. Lorenzutti, and L. Pelligand. (vetlit.org)

Why it matters: Metoclopramide is already used in dogs as an antiemetic and upper GI prokinetic, commonly by IV infusion at roughly 0.01 to 0.02 mg/kg/h, but published guidance has long acknowledged that ideal dosing is uncertain and that some patients may need higher exposure to see a prokinetic effect. Recent clinical review literature notes that CRIs are often preceded by a 0.5 mg/kg bolus, while also warning that higher doses raise the risk of extrapyramidal adverse effects such as agitation, restlessness, hypersalivation, and muscle rigidity. For veterinary teams, this new modelling work helps frame the tradeoff more clearly: faster onset may require a loading dose, but the benefit has to be balanced against concentration-related neurologic risk. (merckvetmanual.com)

What to watch: The next question is whether these model-based dosing proposals translate into better clinical outcomes, not just faster target concentrations, in dogs with vomiting, reflux, or postoperative ileus. (vetlit.org)