Engflag

Viscal

Quick links to important sections

Viscal

Viscal_EN

Treatment option:

Medically reviewed

Marina Burgos

Last updated on 10/01/2026

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Viscal

Understanding Viscal

Viscal is a pharmacological agent primarily classified within the category of bone-modifying agents. It is designed to interact with the physiological processes of bone remodeling, specifically targeting the activity of cells responsible for bone resorption.

Mechanism of Action

The skeletal system is in a constant state of flux, where old bone tissue is removed and new bone tissue is formed. This process is regulated by two primary cell types: osteoblasts, which build bone, and osteoclasts, which break it down. Viscal belongs to the bisphosphonate class of medications. Its primary function is to inhibit the activity of osteoclasts. By binding to the mineral surface of the bone, the medication reduces the rate at which bone is dissolved, thereby helping to maintain or increase bone mineral density over time.

Clinical Applications

Viscal is utilized in several clinical contexts where bone density is compromised or where excessive bone turnover occurs. These conditions include:

  • Osteoporosis: A condition characterized by weakened bones and an increased risk of fractures, often occurring in postmenopausal individuals or as a result of long-term corticosteroid use.
  • Paget's Disease of Bone: A chronic disorder that interferes with the body's normal bone recycling process, leading to bones that are fragile or misshapen.
  • Bone Metastases: In instances where certain types of cancer have spread to the skeletal system, Viscal may be used to manage bone complications and reduce the risk of skeletal-related events.

Pharmacological Properties

Once administered, the active components of Viscal have a high affinity for calcium crystals within the bone matrix. This allows the medication to remain localized in the skeletal tissue for an extended period. The portion of the medication not absorbed by the bone is typically excreted through the renal system. Because the drug targets the mineralized portion of the bone, its effects on bone density are gradual and are usually monitored through diagnostic imaging over several months or years.

What side effects are possible with Viscal?

Possible Side Effects and Safety Information

The safety profile of Viscal (Metoclopramide) is structured around official regulatory classifications of adverse reactions, emphasizing effects on the nervous system and risks associated with treatment duration. All documented information is derived strictly from government regulatory sources.

Documented Adverse Reactions by Frequency

Official prescribing documents classify adverse reactions based on expected occurrence. Somnolence (drowsiness) is classified as a very common adverse reaction, meaning it may affect more than 1 in 10 people. Common documented effects, affecting up to 1 in 10 people, include diarrhoea, asthenia (lack of strength), and hypotension (low blood pressure).

Uncommon reactions include bradycardia (slowed heart rate) and involuntary muscle spasms like dystonia and dyskinesia. Convulsions are classified as a rare event.

Serious Safety Considerations

A critical concern in regulatory labeling is the risk of Tardive Dyskinesia (TD), a serious movement disorder that may be persistent or irreversible. The risk of TD is explicitly tied to the duration of treatment and cumulative dose; official documents advise avoiding use beyond 12 weeks.

Other serious adverse reactions documented in official sources include Neuroleptic Malignant Syndrome (NMS), a rare, potentially life-threatening condition, and cardiovascular events such as cardiac arrest, which have been reported, particularly following intravenous administration.

Population-Specific Notes and Restrictions

Regulatory documents highlight that children and young adults have a higher risk of developing acute Extrapyramidal Disorders. Older adults are at increased risk for the serious, duration-dependent risk of Tardive Dyskinesia. Viscal is formally contraindicated (should not be used) in patients with conditions like gastrointestinal hemorrhage, mechanical obstruction, or a history of epilepsy/seizures, as the medicine's action could worsen these conditions.

Overdose and Emergency Response

The official regulatory profile for Viscal (Metoclopramide) overdose is defined by documented neurological and systemic manifestations. Overdose presentations involve Central Nervous System (CNS) effects, such as severe drowsiness, confusion, and generalized seizures, alongside Extrapyramidal Symptoms (EPS). These movement disorders can include acute dystonic reactions, involuntary twisting of the neck (torticollis), and uncontrollable movements of the limbs or face.

Life-threatening outcomes listed in official documents include the development of Neuroleptic Malignant Syndrome (NMS), which presents with fever and muscle rigidity, and serious cardiovascular events such as hypotension and bradycardia. Immediate medical attention is required for the onset of severe toxicity, including signs of collapse, trouble breathing, or inability to be awakened; in these cases, contact with emergency services is mandated.

Regarding management, regulatory authorities state that no specific antidote is known for Metoclopramide overdose. Treatment is restricted to supportive and symptomatic care, including specific procedural steps for managing severe EPS. A population-specific consideration noted in official labeling is the increased risk of Methemoglobinemia following overdosage in neonates.

Therapeutic Uses of Viscal

What Viscal Treats: Main Uses and Benefits

Viscal is indicated to assist with the temporary relief of symptoms associated with common discomforts. It is utilized to help manage issues, including runny nose, sneezing, itching, and watery eyes. It is also indicated for the temporary management of the feelings of nausea and dizziness, which may be associated with motion. Viscal is a choice for individuals seeking temporary symptom management, particularly when acute episodes of discomfort present. The primary patient benefit of this medicine is contributing to the patient's comfort and helping to temporarily lessen the feeling of acute symptom distress.

“Viscal is utilized to assist with the management of multiple symptoms, such as runny nose and nausea.”

Quick Fact: Temporary relief for itching and nausea

Regulatory References

  1. U.S. National Library of Medicine’s DailyMed page for product listings

Eligibility and Restrictions for Use

Who Can and Cannot Use Viscal?

This section details the official population eligibility rules for Viscal (Metoclopramide) as defined by regulatory authorities.

Contraindicated Populations and Conditions

Viscal is strictly contraindicated and must not be used in several populations. These include children less than one year of age and patients with an established history of metoclopramide-induced tardive dyskinesia. Absolute contraindications related to coexisting conditions include any state involving the risk of stimulating the gut, such as gastrointestinal hemorrhage, mechanical obstruction, or perforation. Patients with pheochromocytoma, epilepsy, or Parkinson's disease are also ineligible due to the risk of exacerbating these conditions.

Restricted and Conditional Use

For pediatric patients aged 1 to 18 years, use is highly restricted and generally limited to specific, short-term, second-line indications as defined by the label. Older adults and patients with severe renal or hepatic impairment are subject to conditional use; eligibility requires careful consideration and usually a mandatory dose reduction to manage the risk of adverse effects, as documented in official prescribing information.

Pregnancy and Lactation Eligibility

Use is generally not recommended during the first trimester of pregnancy and is also not recommended during the period of lactation/breastfeeding.

What should I know about interactions with other medicines?

The drug name Viscal is not recognized as a prescription medicine or drug substance with an official governmental drug interaction profile in major regulatory databases, such as the U.S. Food and Drug Administration (FDA) or the European Medicines Agency (EMA). Consequently, there is no official regulatory labeling that describes specific drug-drug interactions for this product name.

However, some non-prescription or dietary supplements marketed under similar-sounding names typically contain marine extracts, vitamins (like Biotin and Vitamin C), and minerals (like Zinc and Calcium). In a general context, if a product contains ingredients such as calcium or other minerals, potential interactions may exist. For instance, minerals can sometimes interfere with the absorption of certain orally administered medicinal products, requiring a separation of the doses by several hours. These include antibiotics (e.g., tetracyclines, fluoroquinolones) and levothyroxine.

Any product that is not a fully regulated prescription drug will lack the mandated, comprehensive clinical interaction studies and regulatory warnings required for licensed medicines. Patients should review the full list of active components on any product label and discuss any concurrent use of prescription medicines or other supplements with a healthcare professional to prevent potential issues, regardless of official classification.

Mechanism of Action

How Viscal Works

Viscal (Metoclopramide) modulates physiological processes through a unique dual action mechanism, simultaneously targeting central and peripheral pathways by interacting with specific dopamine and serotonin receptors.

Central Antagonism of Emetic Signaling

The drug's primary action modulates the involuntary physiological mechanisms that initiate the expulsion reflex by involving antagonism of dopamine D2 and serotonin 5-HT3 receptors in the Chemoreceptor Trigger Zone (CTZ), a key sensory area in the brainstem. By blocking these targets, the drug intercepts chemical signals from the bloodstream and gut wall that typically initiate the central emetic signaling pathway. This central signal suppression reduces the transmission of excessive chemical mediator activity to the neural regulatory pathway for the expulsion reflex.

Peripheral Regulation of Upper Gut Movement

In the digestive tract, the drug functions as an agonist at serotonin 5-HT4 receptors within the Enteric Nervous System (ENS), which promotes the release of the neurotransmitter acetylcholine (ACh). The resulting surge in ACh enhances the strength and coordination of smooth muscle contractions in the stomach and upper small intestine. This peripheral mechanism initiates or suppresses signaling sequences that lead to the predictable physiological adjustment of increased rate and coordination of upper gastrointestinal transit.

Dosage and Administration Information

How to Use Viscal: Official Administration Guidelines

The usage of Viscal (Metoclopramide) is defined by instructions concerning the form, route, and timing of administration. It is available for oral use as tablets, solutions, or orally disintegrating tablets (ODT), and for parenteral use via intravenous (IV) or intramuscular (IM) injection.

Oral dosing generally involves a standard amount of 10 mg per dose, taken up to three or four times daily, depending on the specific condition. A core requirement for oral administration is timing: doses must be taken on an empty stomach, specifically 30 minutes before each meal and at bedtime.

Frequency and Duration Constraints

The most important constraint is the minimum dosing interval: an interval of at least 6 hours must be maintained between all administrations of the immediate-release form. This rule applies even if a dose is partially or fully rejected. The total duration of use is limited, differentiating between contexts:

  • Acute Nausea and Vomiting: Treatment must be limited to a maximum of 5 consecutive days.
  • Chronic Conditions (e.g., Gastroparesis): Use should not exceed 12 weeks in duration.

Specific Procedural Instructions

Dose Adjustment: Patients with confirmed renal or hepatic impairment require dose reduction, typically to 50% of the usual dose. For parenteral administration, IV doses must be administered slowly over a period of at least 3 minutes to comply with official guidelines. If a dose is missed, it must be skipped, and the patient should resume the schedule with the next dose at the usual time; doubling a dose is not permitted.

Recent Clinical Evidence

Research evidence / Overview of studies for Viscal

Viscal (Metoclopramide) was evaluated in various types of clinical research, including randomized controlled trials (RCTs) and systematic reviews, which were used in research exploring how symptoms change over time. The overall research base is used by regulatory agencies to assess the evidence detailing the research contexts for symptom evaluation.

Evidence for Use in Diabetic Gastroparesis Symptoms

Research for this use focused on symptoms related to the delayed emptying of the stomach often associated with diabetes. Short-term RCTs examined populations experiencing symptoms and compared the medicine against a non-active placebo. Studies monitored the reported frequency and severity of nausea and vomiting and documented the measurements observed among participants. However, the follow-up durations were limited, and long-term effects are not fully established regarding whether short-term measured changes are sustained.

Evidence for Use in Post-Surgical Nausea and Vomiting (PONV)

The research for preventing post-operative sickness is derived from numerous studies, including comprehensive meta-analyses that pool data from multiple Double-blind RCTs. These trials were applied in studies examining patient-reported experiences after different types of surgery. Studies monitored the measured incidence of nausea or vomiting/retching within the first 24 hours. Comparative evidence is lacking for many potential drug combinations, and the research primarily describes the short-term impact over defined time intervals immediately following the procedure.

Key Research Gaps and Uncertainty

Regulatory review of the evidence notes that certainty remains low in several areas, particularly concerning use beyond short-term treatment. The follow-up durations were limited in many pivotal trials, restricting the knowledge about the long-term impact on outcomes reflecting daily functioning. The evidence is limited regarding the medicine's role in many conditions characterized by fluctuating manifestations when administered over extended periods.

Key Studies & References

  1. Metoclopramide: risk of neurological adverse effects - UK Government (EMA review restricting dose and duration of use)
  2. Metoclopramide for nausea and vomiting prophylaxis during and after Caesarean delivery: a systematic review and meta-analysis - Scholars@Duke (Specific PONV population)

Frequently Asked Questions (FAQ)

Common questions about Viscal (FAQ)

Q: Is it okay to take Viscal with my daily vitamin or supplement?

Regulatory information suggests that patients disclose all products they are currently taking with a healthcare provider. This includes prescription and nonprescription medicines, as well as vitamins, nutritional supplements, and herbal products. Disclosing all products is important for assessing potential interactions or changes in how the medicine works.

Q: How does Viscal affect the liver or kidneys?

Viscal's active ingredient is processed by the body and eliminated through the kidneys and, to a lesser extent, the liver. Regulatory information indicates that for individuals with kidney or liver impairment, the medicine's clearance may be reduced. Regulatory information states that dose adjustments are typically required in these populations to prevent the drug from accumulating in the body.

Q: What is the shelf life of Viscal?

The stability and shelf life of the medicine depend on its specific formulation and packaging. For example, some injectable forms have a shelf life of 24 months. Generally, tablets should be stored at a controlled room temperature, kept in the original packaging, and protected from light until the expiry date.

Q: Can Viscal be used if a person has diabetes?

Official labeling describes this medicine’s use for a complication linked to diabetes known as Diabetic Gastroparesis (delayed stomach emptying). However, official warnings also note that patients with diabetes may be at an increased risk for developing certain serious movement disorders, such as tardive dyskinesia, when using the medicine.

Q: What does 'contraindication' mean in relation to Viscal?

A contraindication refers to any condition, circumstance, or prior event that makes the use of a drug inappropriate and potentially harmful. According to official labeling, if a patient has a condition listed as a contraindication, the risks of taking Viscal are judged to outweigh any possible benefit. Official regulatory guidance states that the medicine is not to be used in these specific circumstances.

Q: Is Viscal the same kind of medicine as [similar drug name]?

According to pharmacological classification, the active ingredient in Viscal is categorized as both an antiemetic agent and a prokinetic agent. This dual classification indicates that it works to suppress feelings of nausea while also stimulating movement in the upper digestive tract (GI stimulant).

Q: How quickly should I notice Viscal starting to work?

The onset of the pharmacological effect for the oral forms (tablets or solution) is typically noted within 30 to 60 minutes after taking the dose. This time reflects how quickly the active ingredient begins its function in the body.

Q: How long does the effect of a Viscal dose last?

The primary pharmacological effects of a single dose are relatively short-lived. Regulatory documents indicate that the beneficial effects typically last between 1 to 2 hours.

Q: Are there any known interactions between Viscal and alcohol?

Official warnings state that alcohol can increase certain side effects of the medicine, particularly those affecting the central nervous system. These can include increased feelings of drowsiness, dizziness, and difficulty concentrating. Official regulatory guidance suggests that a healthcare professional should be consulted regarding the use of alcohol during treatment.

Q: Are there different brand names for the same medicine as Viscal?

Yes, Viscal contains the active ingredient metoclopramide, which is also sold under several other brand names globally. Examples of other brand names for the same core medicine include Reglan, Metozolv ODT, Gimoti, and Maxolon.

Q: How common are allergic reactions to Viscal?

Adverse reactions are officially classified by their expected frequency. Hypersensitivity (a type of allergic reaction) is listed as an uncommon side effect, meaning it is expected to affect between 0.1% and 1% of patients. More severe reactions, such as anaphylaxis, are documented as a rare event.

Q: How long does it take for Viscal to be completely out of the body?

The elimination half-life, which measures the time needed for the amount of medicine in the body to drop by half, averages 5 to 6 hours in individuals with normal kidney function. Regulatory documents estimate that most of the dose (approximately 85%) is excreted in the urine within 72 hours.

How should Viscal be stored and disposed of?

How to Store and Dispose of Viscal?

Viscal (Metoclopramide) must be stored and handled according to specific official instructions to maintain product stability.

Official Storage Requirements

Condition Requirement
Temperature Store at controlled room temperature, typically between 20 C and 25 C (68 F and 77 F).
Protection Keep the medicine out of the reach and sight of children. Protect from freezing and excess heat.
Container Keep the oral solution bottle tightly closed and store light-sensitive forms in the original carton.
Stability Oral solutions have a limited in-use stability period after opening (e.g., must be discarded after 60 days).

Disposal

Expired or unused Viscal must not be disposed of via household trash or wastewater (e.g., pouring down the sink). Disposal must be completed in accordance with local requirements or through an official medicine take-back program. Used injection materials must be placed in a puncture-resistant sharps container.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

Equivalent of Viscal found in:

A-Z Index: