From the Guidelines
The best medication for gastroparesis is metoclopramide, which is the only FDA-approved medication for this condition, and it should be used at a standard dosage of 10 mg taken 30 minutes before meals and at bedtime, limited to 12 weeks due to the risk of tardive dyskinesia with long-term use. According to the most recent study 1, metoclopramide is a prokinetic agent that is approved by the FDA for the treatment of gastroparesis. The study also mentions that withdrawing drugs with adverse effects on gastrointestinal motility, including opioids, anticholinergics, TCAs, GLP-1 RAs, and pramlintide, may also improve intestinal motility.
Some key points to consider when treating gastroparesis include:
- The use of metoclopramide is recommended for moderate to severe cases of gastroparesis, as it has been shown to improve symptoms and gastric emptying 1.
- Alternative medications, such as domperidone and erythromycin, may be considered for patients who do not respond to metoclopramide or have contraindications to its use 1.
- Dietary modifications, such as eating smaller, more frequent meals, limiting fat and fiber intake, and staying well-hydrated, are essential components of gastroparesis management 1.
- Other treatment options, such as gastric electrical stimulation and enteral feeding, may be considered for patients with severe gastroparesis who do not respond to medical therapy 1.
It's worth noting that the level of evidence regarding the benefits of metoclopramide for the management of gastroparesis is weak, and its use should be balanced against the potential risks, such as extrapyramidal signs and tardive dyskinesia 1. However, based on the most recent and highest-quality study available 1, metoclopramide remains the best medication for gastroparesis.
From the FDA Drug Label
INDICATIONS AND USAGE Diabetic Gastroparesis (Diabetic Gastric Stasis) Metoclopramide is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis. The best medication for gastroparesis is metoclopramide 2.
- Key points:
- Metoclopramide is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis.
- The dosage and administration of metoclopramide may vary depending on the severity of symptoms and patient factors, such as renal or hepatic impairment 2.
- Patients should be cautioned about the potential side effects of metoclopramide, including extrapyramidal reactions, and the importance of proper dosage and administration 2.
From the Research
Medications for Gastroparesis
The following medications have been studied for the treatment of gastroparesis:
- Metoclopramide: a prokinetic agent that is the only Food and Drug Administration-approved medication for gastroparesis 3
- Domperidone: a prokinetic agent that has been shown to stimulate gastric motility and possess antiemetic properties 4, 5
- Erythromycin: an antibiotic that has been used as a prokinetic agent in the treatment of gastroparesis, particularly in cases where other treatments have failed 6
- Cisapride: a prokinetic agent that has been shown to have continued beneficial effects on gastric motility with long-term therapy 5
Potential Interactions and Side Effects
When using these medications, potential interactions and side effects should be considered:
- Drug-drug interactions: the co-administration of several classes of pharmacological agents can lead to changes in systemic levels of prescribed drugs, potentially resulting in undesired clinical outcomes 7
- Adverse effects: all three agents (metoclopramide, domperidone, and cisapride) have favorable adverse-effect profiles, but tolerance to stimulation of gastric emptying may develop with long-term therapy 5
Treatment Approaches
Treatment approaches for gastroparesis may involve:
- Correction of malnutrition, dehydration, and electrolyte imbalance
- Relief of symptoms using prokinetic and antiemetic agents
- Optimization of glycaemic control in patients with diabetes-associated gastroparesis 4