Can I use Reglan (Metoclopramide) for gastroparesis?

From the Guidelines

Reglan (metoclopramide) should only be used for gastroparesis in severe cases that are unresponsive to other therapies, due to the risk of serious adverse effects, and its use should be limited to 12 weeks or less. According to the most recent guidelines, treatment for diabetic gastroparesis may involve a low-fiber, low-fat eating plan, small frequent meals, and withdrawing drugs with adverse effects on gastrointestinal motility 1. In cases of severe gastroparesis, pharmacologic interventions are needed, and metoclopramide is the only prokinetic agent approved by the FDA for this condition. However, the level of evidence regarding its benefits is weak, and its use is associated with serious adverse effects such as extrapyramidal signs, including acute dystonic reactions, drug-induced parkinsonism, akathisia, and tardive dyskinesia 1. Other treatment options include domperidone and erythromycin, which may be considered before metoclopramide due to its potential risks.

Some key points to consider when using Reglan for gastroparesis include:

• The typical dose is 5-10 mg taken 30 minutes before meals and at bedtime
• Treatment duration should be limited to 12 weeks or less to minimize the risk of serious adverse effects
• Potential side effects include drowsiness, restlessness, fatigue, and diarrhea, as well as more serious side effects such as involuntary muscle movements
• Reglan may not be appropriate for patients with certain medical conditions or those taking medications that could interact with it, so consultation with a healthcare provider is necessary before starting this medication 1.

It is essential to weigh the potential benefits of Reglan against its risks and consider alternative treatment options before initiating therapy. Given the limited evidence supporting its use and the potential for serious adverse effects, Reglan should be reserved for severe cases of gastroparesis that are unresponsive to other therapies.

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.

• Yes, Reglan (metoclopramide) can be used for gastroparesis, specifically for the relief of symptoms associated with acute and recurrent diabetic gastric stasis 2.
• The dosage for the relief of symptoms associated with diabetic gastroparesis is described in the label, with oral administration of metoclopramide as an option if only the earliest manifestations of diabetic gastric stasis are present 2.

From the Research

Gastroparesis Treatment

• Gastroparesis is a neurogastrointestinal disorder of motility characterized by delayed gastric emptying without mechanical obstruction, with symptoms including nausea, vomiting, and bloating 3.
• The management of gastroparesis involves nutritional support, medications, and procedures, with metoclopramide being the only Food and Drug Administration-approved medication for gastroparesis 3, 4, 5.

Metoclopramide for Gastroparesis

• Metoclopramide is a dopamine receptor antagonist with 5HT3 receptor antagonist and 5HT4 receptor agonist activity, used as an antiemetic and gastroprokinetic 6, 4.
• Metoclopramide enhances the rate of gastric emptying by augmenting esophageal peristalsis, gastric antral contractions, and small intestine transit time, and increasing resting pressures of the lower esophageal and pyloric sphincters 7.
• The side effects of metoclopramide are usually mild, transient, and reversible with discontinuation of the drug, but may include drowsiness, GI disturbances, extrapyramidal reactions, and increased lactation 7.

Risk of Tardive Dyskinesia

• The risk of tardive dyskinesia from metoclopramide is low, in the range of 0.1% per 1000 patient years, with high-risk groups including elderly females, diabetics, patients with liver or kidney failure, and patients with concomitant antipsychotic drug therapy 6.
• Metoclopramide carries a black box warning for use >12 weeks due to the risk of tardive dyskinesia, but gastroparesis patients often require prolonged treatments 4, 5.

Reglan (Metoclopramide) for Gastroparesis

• Reglan is another name for metoclopramide, which is used to treat gastroparesis 3, 4, 5.
• The evidence suggests that metoclopramide, or Reglan, can be used to treat gastroparesis, but patients should be aware of the potential risks and side effects, including tardive dyskinesia 3, 6, 4, 7, 5.