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Gastroparesis is a chronic condition that affects the stomach muscles and prevents proper stomach emptying. For those living with this condition, managing symptoms can often be a challenging journey. Fortunately, prokinetic drugs can provide some relief by enhancing gastric motility. In this blog post, we’ll break down what prokinetic drugs are, some commonly used options, and how they compare to each other.
What Are Prokinetic Drugs?
Prokinetic drugs are medications that help stimulate the movement of the stomach and intestines. They are often prescribed to relieve symptoms associated with gastroparesis, such as nausea, vomiting, bloating, and fullness after eating small meals.
Common Prokinetic Drugs
Let’s take a closer look at a few of the most commonly prescribed prokinetic drugs for gastroparesis, their mechanisms of action, potential benefits, and side effects.
Metoclopramide (Reglan)
Mechanism: Metoclopramide works by blocking dopamine receptors and increasing the levels of acetylcholine, which helps speed up gastric emptying. It is the only FDA-approved drug for gastroparesis.
Benefits: Effective for nausea and vomiting. Improves gastric motility.
Side Effects: Drowsiness, fatigue, and possible development of tardive dyskinesia (a movement disorder characterized by facial twiches or seizures) with long-term use; therefore, it is not recommended to be given for longer than 12 weeks. Because tardive dyskinesia does not fully resolve in 25-50% of patients, many patients do not want to take it and many physicians are reluctant to prescribe it.
Considerations: Metoclopramide is often one of the first-line treatments but is usually recommended for short-term use due to the risk of side effects. Furthermore, it typically becomes less effective over time (see our blog post: Why does Reglan (or generic metoclopramide) no longer work for my gastroparesis?).
Domperidone (Motilium)
Mechanism: Domperidone acts as a peripheral dopamine antagonist, meaning it increases gastric emptying without crossing the blood-brain barrier as much as metoclopramide does.
Benefits: Less risk of central nervous system side effects such as tardive dyskinesia. Effective at relieving nausea.
Side Effects: Gastrointestinal disturbances. Possible cardiac effects, including arrhythmias, in those with pre-existing conditions. Potential serious interactions with other drugs.
Considerations: Domperidone is not available in the United States. While it can be ordered from non-US pharmacies, it is not approved by the FDA and not covered by medical insurance plans. It also may require careful monitoring, most commonly repeat EKGs.
Erythromycin
Mechanism: Erythromycin is an antibiotic that acts as a motilin receptor agonist, promoting contractions in the stomach.
Benefits: Rapid onset of action. May help with gastric emptying and reduce nausea.
Side Effects: Gastrointestinal symptoms such as diarrhea. Potential for developing antibiotic resistance with long-term use. Potential serious interactions with other drugs.
Considerations: While erythromycin may be helpful, it is typically recommended for short-term use due to the risk of antibiotic resistance. Patients might also be advised to use this option only when other treatments have failed.
Baclofen
Mechanism: Baclofen is a muscle relaxant that can alter gastric motility by inhibiting neurotransmitter release.
Benefits: Useful in certain patients who might experience crampy upper abdominal pain from hypertonic gastric contractions.
Side Effects: Drowsiness, fatigue, and potential withdrawal symptoms if stopped abruptly.
Considerations: Baclofen is less commonly used as a primary treatment but can be helpful in particular patient populations.
Comparing the Options
When choosing a prokinetic drug, it’s critical to consider the individual patient’s needs, potential side effects, and the goal of treatment. Here’s a quick comparison:
| Drug | Main Benefits | Common Side Effects | Duration of Use |
|---|---|---|---|
| Metoclopramide | Effective for nausea, improves motility | Drowsiness, tardive dyskinesia | Short-term preferred |
| Domperidone | Fewer CNS side effects, effective nausea | GI issues, cardiac concerns | Requires monitoring |
| Erythromycin | Fast-acting, helps with motility | Diarrhea, antibiotic resistance | Short-term |
| Baclofen | Alleviates hypertonic contractions | Drowsiness, withdrawal symptoms | Specific indications only |
Final Thoughts
Finding the right treatment for gastroparesis can take time and may require a combination of lifestyle changes, dietary adjustments, and medications. It’s essential to work closely with your healthcare provider to determine the most appropriate prokinetic drug based on your specific symptoms, medical history, and potential side effects.
As you navigate this journey, remember that you are not alone. Many patients with gastroparesis face similar challenges, and sharing experiences and strategies can be incredibly helpful. Always consult with your healthcare professional before making any changes to your medication regimen.