From the Guidelines
Perinorm (metoclopramide) is effective for improving gastric motility disorders, but its use should be limited to 4-12 weeks due to the risk of serious adverse effects, as recommended by the FDA and the European Medicines Agency 1. The standard dosage is 10 mg three times daily before meals for adults. Metoclopramide works by blocking dopamine receptors in the chemoreceptor trigger zone and stimulating serotonin (5-HT4) receptors in the gut, which enhances gastric emptying and increases lower esophageal sphincter tone. This dual mechanism helps treat conditions like gastroparesis, gastroesophageal reflux disease (GERD), and functional dyspepsia. Important considerations include potential side effects such as extrapyramidal symptoms (especially with prolonged use beyond 12 weeks), drowsiness, and restlessness. The medication should be used cautiously in elderly patients, those with renal impairment, and is contraindicated in patients with seizure disorders, pheochromocytoma, or those taking medications that might interact with metoclopramide. For optimal effectiveness, patients should take the medication 30 minutes before meals and at bedtime. Other treatment options for gastroparesis include domperidone, erythromycin, and gastric electrical stimulation, but metoclopramide is the only FDA-approved medication for this condition 1. It is essential to weigh the benefits of metoclopramide against its potential risks and to consider alternative treatments, especially for long-term use or in patients with certain comorbidities 1.
Some key points to consider when prescribing Perinorm (metoclopramide) include:
- The medication should be used for a limited duration (4-12 weeks) to minimize the risk of adverse effects
- Patients should be monitored closely for signs of extrapyramidal symptoms, such as acute dystonic reactions, drug-induced parkinsonism, akathisia, and tardive dyskinesia
- The medication should be used cautiously in elderly patients, those with renal impairment, and those taking medications that might interact with metoclopramide
- Alternative treatments, such as domperidone and erythromycin, may be considered for patients who are unresponsive to metoclopramide or who experience adverse effects.
From the FDA Drug Label
Do not use in horses with suspected or confirmed gastrointestinal blockage, as domperidone is a prokinetic drug (it stimulates gut motility). The drug domperidone stimulates gastric motility.
- Perinorm CD is not mentioned in the label, but domperidone is, and it affects gastric motility by stimulating it. 2
From the Research
Gastric Motility and Prokinetic Agents
- Prokinetic agents are used to improve gastric motility in conditions such as gastroparesis and gastroesophageal reflux 3, 4, 5.
- These agents work by amplifying and coordinating gastrointestinal muscular contractions to facilitate the transit of intra-luminal content 5.
- Examples of prokinetic agents include metoclopramide, domperidone, and macrolides, which have different mechanisms of action and potential side effects 6, 5, 7.
Perinorm CD and Gastric Motility
- There is no direct mention of Perinorm CD in the provided studies, making it difficult to determine its specific effects on gastric motility.
- However, the studies discuss various prokinetic agents and their potential to improve gastric motility and relieve symptoms of gastroparesis 3, 4, 5, 7.
Prokinetic Agents and Their Effects
- Prokinetic agents have been shown to improve motility function in all segments of the digestive tract, from the esophagus to the colon 7.
- The use of prokinetic agents can be associated with potential side effects, such as arrhythmias and galactorrhea 7.
- Newer agents are being developed to target diverse gastric motor functions, including novel serotonergic 5-HT4 agonists and dopaminergic D2/3 antagonists 5.