Which diabetes medications can cause gastroparesis?

From the Guidelines

Diabetes medications that can cause or worsen gastroparesis include GLP-1 receptor agonists, such as exenatide, liraglutide, semaglutide, and dulaglutide, as well as amylin analogs like pramlintide, according to the most recent evidence 1. These medications work by slowing gastric emptying, which can exacerbate or trigger gastroparesis symptoms in susceptible individuals.

• GLP-1 receptor agonists are the most commonly associated class of medications with gastroparesis.
• Amylin analogs, such as pramlintide, also slow gastric emptying and may contribute to gastroparesis.
• Other medications, such as SGLT-2 inhibitors, like empagliflozin or dapagliflozin, may also cause delayed gastric emptying, although this is less common.
• Metformin, while generally well-tolerated, can cause gastrointestinal side effects that might be confused with gastroparesis symptoms. Individuals with diabetes who already have autonomic neuropathy affecting the digestive system are particularly vulnerable to developing medication-induced gastroparesis 1. If gastroparesis symptoms develop, healthcare providers may need to adjust medication dosages or switch to alternative diabetes treatments. The risk of removal of GLP-1 RAs should be balanced against their potential benefits, and other treatment options, such as domperidone and erythromycin, may be considered in severe cases 1.

From the Research

Diabetes Medications and Gastroparesis

The relationship between diabetes medications and gastroparesis is complex, with some medications potentially exacerbating or contributing to the condition.

• Gastroparesis is a complication of diabetes characterized by delayed gastric emptying, which can lead to symptoms such as nausea, vomiting, and bloating 2.
• Certain medications, including some used to treat diabetes, can slow gastric emptying and worsen gastroparesis symptoms 2.
• However, the provided studies do not specifically identify which diabetes medications can cause gastroparesis, instead focusing on treatments for the condition, such as metoclopramide, erythromycin, and domperidone 3, 4, 5.

Treatment of Diabetic Gastroparesis

Treatment for diabetic gastroparesis often involves prokinetic agents, which help stimulate gastric emptying.

• Erythromycin, a macrolide antibiotic, has been shown to be effective in treating diabetic gastroparesis by enhancing gastric emptying and improving glycemic control 4, 5.
• Metoclopramide is another medication that has been used to treat diabetic gastroparesis, with studies demonstrating its ability to improve gastric emptying and reduce symptoms 3, 5.
• Other treatments, such as gastric neuromodulation and surgical interventions, may also be considered for patients with medication-refractory diabetic gastroparesis 2.

Alternative Treatments

Complementary and alternative medical treatments, such as acupuncture and massage, are being explored as potential therapies for diabetic gastroparesis.

• These treatments may offer fewer side effects and lower costs compared to traditional Western medical approaches 6.
• However, more research is needed to fully understand the mechanisms and effectiveness of these alternative therapies in treating diabetic gastroparesis 6.