This study in the Islamic Republic of Iran aimed to determine whether metoclopramide can prevent nosocomial pneumonia in the intensive care unit (ICU). Of 220 patients admitted to the surgical ICU who had a nasogastric tube for more than 24 hours, 68 case patients received oral metoclopramide (10 mg every 8 hours) and 152 control patients did not. Similar proportions of cases and controls developed nosocomial pneumonia (33.8% versus 33.6%). Endotracheal intubation was a risk factor for nosocomial pneumonia (odds ratio 7.70). There were no significant differences between groups in mortality rate or time of onset of nosocomial pneumonia. Metoclopramide appears to have no effect on the development of nosocomial pneumonia with nasogastric feeding.