Primperan (Metoclopramide) in Spain: What It Is For and Why It Needs a Prescription

Primperan is a Spanish brand of metoclopramide, an anti-sickness medicine. Adults use it for sickness from migraine, chemotherapy, radiotherapy or surgery. It is for a few days only and needs a prescription in Spain. This guide is by Dr. Pedro Yelamo Vera, a GP licensed in Spain (Colegiado No. 484814280) who sees patients by video in English and Spanish.

What is Primperan?

Primperan is the best-known Spanish brand of metoclopramide. It is an anti-sickness medicine (an antiemetic). Spanish pharmacies also sell generic metoclopramide, with the same active ingredient.

What is Primperan used for?

In adults, the Spanish product information for its different forms (tablets, oral solution, injection) lists these uses between them:

• to treat nausea and vomiting, including sickness during a migraine attack;
• to prevent delayed sickness after chemotherapy;
• to prevent sickness caused by radiotherapy;
• to prevent sickness after an operation (the injection).

In migraine, it can be taken with a painkiller by mouth. It helps the painkiller get absorbed. Your doctor decides if this suits you.

What is it no longer used for?

In 2013 the Spanish medicines agency (AEMPS) narrowed its use after a European review. It is no longer meant for acid reflux, indigestion (dyspepsia) or a slow-emptying stomach (gastroparesis). It is also no longer used to help with scans or surgery.

What is the active ingredient?

The active ingredient is metoclopramide, as the hydrochloride salt. If the pharmacy gives you generic metoclopramida, it is the same medicine.

Why is it for a few days only?

Because it can affect the nervous system. So since 2013 the rule in Spain is a maximum of 5 days.

• Unwanted movements (extrapyramidal effects): spasms, mostly of the head and neck. They are more common in children and young adults. They can happen even after one dose.
• Tardive dyskinesia: unwanted movements after long use. They may not go away when you stop.
• Heart effects: low blood pressure, a slow pulse and, rarely, serious rhythm problems. These are mostly linked to the injection into a vein.

If you have been taking metoclopramide often, ask your doctor to review it.

Can children take it?

Not babies under 1 year: it must not be used. From 1 to 18 years it is only a second choice. It may prevent delayed sickness after chemotherapy, or treat sickness after an operation. It is not meant for a child's tummy bug. For young children, the key is to keep them drinking.

Who should not take Primperan?

Do not take it, and tell the doctor, if you:

• are allergic to metoclopramide or anything else in it;
• have bleeding, a blockage or a tear in the stomach or gut;
• have, or may have, a rare adrenal gland tumour (phaeochromocytoma);
• have ever had tardive dyskinesia from a medicine;
• have epilepsy or Parkinson's disease;
• take levodopa or other dopamine medicines for Parkinson's;
• have had methaemoglobinaemia (a blood problem) or lack the enzyme NADH cytochrome b5 reductase.

Check with a doctor first if

• you are older, or have severe kidney or liver disease: the dose needs changing;
• you have heart rhythm problems, a slow pulse or low salts in the blood;
• you are pregnant: it can be used if needed, but it is avoided late in pregnancy;
• you are breastfeeding: it is not recommended;
• you cannot digest lactose (the tablets contain it).

Which medicines interact with it?

• Levodopa and dopamine agonists: do not combine them. They work against each other.
• Alcohol: avoid it. It makes drowsiness worse.
• Sleeping pills and other sedatives: more drowsiness.
• Antipsychotics: a higher risk of unwanted movements.
• SSRI antidepressants: a risk of serotonin syndrome. Fluoxetine and paroxetine also raise its levels.
• Digoxin, ciclosporin and rifampicin: your doctor may need to watch you more closely.
• Opioids and anticholinergic medicines: they cancel out its effect on the stomach.

Possible side effects

The most common is drowsiness. Other common ones are diarrhoea, tiredness, low mood and low blood pressure. Some people get unwanted movements, stiffness like Parkinson's, or restlessness (akathisia). It can cause sleepiness, dizziness and blurred vision. So do not drive until you know how it affects you.

Do you need a prescription for Primperan in Spain?

Yes. The AEMPS register (CIMA) lists every Primperan and generic metoclopramide product as prescription-only. A Spanish pharmacy will ask for a Spanish prescription. That can be a public one or a private electronic one. Spanish pharmacies ask for a prescription from a doctor licensed in Spain, so a foreign prescription is normally refused.

What is it called in the UK and US?

The generic name is metoclopramide everywhere. In the UK it is also prescription-only, and the NHS lists Maxolon as a common brand. The NHS also says it is usually given for a short time. In the US the brand is Reglan. There it is also used for reflux and slow stomach emptying, uses that Europe dropped in 2013.

What forms does it come in?

In Spain there are Primperan tablets, Primperan oral solution and Primperan injection. The injection goes into a vein or a muscle. Generics come in the same forms. The form and amount are set by your prescription; always follow the leaflet.

When to see a doctor

• Vomiting lasts more than a day, or you cannot keep fluids down.
• You are sick often and want to know why.
• You get unwanted movements or restlessness on it: stop and tell your doctor.
• You have taken it for more than 5 days, or use it often.

When to call 112

• Swelling of the face, lips or throat, or trouble breathing.
• High fever with stiff muscles, sweating and confusion.
• A fit (seizure) or passing out.
• Vomiting blood or what looks like coffee grounds, or sudden, severe tummy pain.
• A child who is very drowsy, floppy or hard to wake.

Frequently asked questions about Primperan

Getting a medical assessment

If you are in Spain with nausea or vomiting, or are unsure whether Primperan suits you, you can book a video consultation with Dr. Pedro Yelamo Vera, a physician registered in Spain. You can also read about food poisoning and gastroenteritis in Spain, how long a stomach bug is contagious and migraine. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

This guide is general information. It does not replace the package leaflet or the advice of your doctor or pharmacist.