From the Guidelines
Domperidone is preferred over Reglan (Metoclopramide) for the treatment of gastroparesis due to its better side effect profile, particularly concerning neurological effects, as evidenced by its limited ability to cross the blood-brain barrier 1. When comparing Reglan (Metoclopramide) and Domperidone for treating gastroparesis, several factors come into play, including availability, side effect profiles, and regulatory status.
- Metoclopramide is FDA-approved in the US and is typically prescribed at 5-10 mg three to four times daily before meals and at bedtime.
- However, its use is generally limited to 12 weeks due to the risk of tardive dyskinesia and other neurological side effects such as extrapyramidal symptoms, anxiety, and depression 1.
- Domperidone, while not FDA-approved in the US, is widely used internationally at doses of 10-20 mg three to four times daily before meals and has a better neurological side effect profile because it doesn't readily cross the blood-brain barrier.
- Both medications carry risks of QT prolongation and cardiac arrhythmias, requiring ECG monitoring, especially in patients with heart conditions or taking other QT-prolonging drugs.
- For most patients with gastroparesis requiring prokinetic therapy, consideration of domperidone is recommended, especially for those who cannot tolerate metoclopramide's neurological side effects, given its preferable side effect profile for long-term use 1.
From the Research
Comparison of Reglan (Metoclopramide) and Domperidone
- Reglan (Metoclopramide) and Domperidone are two prokinetic agents used to treat gastroparesis, a disorder characterized by delayed gastric emptying due to chronic abnormal gastric motility 2, 3.
- Both drugs have been shown to improve symptoms of gastroparesis, including nausea, vomiting, early satiety, postprandial fullness, and upper abdominal pain 4, 2, 5, 6.
- Domperidone has been found to improve overall gastroparesis symptom severity, reducing early satiety, postprandial fullness, and nausea, with significant improvements seen as early as day 3 of treatment 4.
- Metoclopramide, on the other hand, has been shown to effectively decrease mean gastric emptying time, although tolerance to this stimulation of gastric emptying may develop with long-term therapy 2.
- Both drugs have favorable adverse-effect profiles, although domperidone has a lower propensity to cause extrapyramidal side effects compared to metoclopramide 2, 5, 6.
- The choice between Reglan (Metoclopramide) and Domperidone may depend on individual patient factors, such as the presence of diabetes, the severity of symptoms, and the potential for drug-drug interactions 2, 3, 6.
Efficacy and Safety
- Studies have shown that domperidone is effective in alleviating symptoms of chronic postprandial dyspepsia and nausea and vomiting due to a wide variety of underlying causes, and may be superior to metoclopramide in some cases 5, 6.
- Domperidone has also been found to be safe and effective in children, with no evidence of extrapyramidal side effects 5.
- Metoclopramide, on the other hand, has been associated with a higher risk of extrapyramidal side effects, particularly with long-term use 2, 6.
Drug-Drug Interactions
- Both Reglan (Metoclopramide) and Domperidone may be subject to drug-drug interactions, particularly when co-administered with other prokinetic agents, antiemetic agents, or antidiabetic agents 3.
- Healthcare providers should be aware of the potential for drug-drug interactions and monitor patients closely for adverse effects when using these medications 3.