What medications are used to treat ileus?

From the Guidelines

Medications used to treat ileus include prokinetic agents such as prucalopride, erythromycin, and neostigmine, which stimulate gastrointestinal motility to help resolve the intestinal paralysis. The choice of medication depends on the underlying cause of the ileus and the patient's individual needs.

• Prokinetic agents like prucalopride [ 1 ] have been shown to be effective in treating ileus, particularly in patients with chronic small intestinal dysmotility.
• Erythromycin, a motilin agonist, is potentially useful if there are absent or impaired antroduodenal migrating complexes [ 1 ].
• Neostigmine, a parasympathomimetic, can enhance parasympathetic activity in the gut and increase intestinal motility [ 1 ]. It's also important to consider the potential side effects and interactions of these medications, as well as the need for careful monitoring and adjustment of treatment as needed. In addition to medication therapy, other management strategies such as nasogastric tube decompression, correction of electrolyte imbalances, and early mobilization are also crucial in treating ileus [ 1 ]. The use of opioids should be cautious, as they can worsen ileus, and alternative pain management strategies should be considered [ 1 ]. Overall, a comprehensive approach to treating ileus should take into account the individual patient's needs and underlying condition, and should involve a combination of medication therapy and other management strategies.

From the FDA Drug Label

Giving a promotility drug such as metoclopramide theoretically could put increased pressure on suture lines following a gut anastomosis or closure The effects of metoclopramide on gastrointestinal motility are antagonized by anticholinergic drugs and narcotic analgesics

Medications to use for ileus:

• Metoclopramide is a promotility drug that can be used to treat ileus, as it helps to increase gastrointestinal motility 2 3.
• It is essential to exercise caution when using metoclopramide, especially in patients with certain medical conditions, such as hypertension, cirrhosis, or congestive heart failure.
• Additionally, metoclopramide should be used with caution in patients receiving other medications, such as anticholinergic drugs, narcotic analgesics, or monoamine oxidase inhibitors.

From the Research

Medications for Ileus

• Neostigmine is a parasympathomimetic drug that acts as a reversible acetylcholinesterase inhibitor, used to treat ileus, including postoperative ileus and acute colonic pseudo-obstruction 4, 5, 6, 7.
• Neostigmine can be administered intravenously, with a dose of 2 mg, to help relieve severe abdominal distention and ileus 4, 6.
• The use of neostigmine has been shown to be effective in facilitating gut decontamination in patients with drug-induced ileus 5.
• Metoclopramide and erythromycin have also been used to treat methamphetamine-induced ileus, a rare complication of methamphetamine intoxication 8.

Administration and Efficacy

• Neostigmine can be administered as a bolus or infusion, with both methods leading to prompt evacuation of flatus or stool and reduction in abdominal distention 4.
• The median duration of neostigmine's effect is noted to be 4-30 minutes in some trials 4.
• Neostigmine has been shown to be safe and effective in treating postoperative ileus in orthopedic spinal patients 6 and critical illness-related colonic ileus in intensive care patients with multiple organ failure 7.

Side Effects and Complications

• The most frequent side effect of neostigmine is abdominal pain/cramping 4.
• Other complications include bradycardia, which is very infrequently symptomatic and may require atropine 4.
• Ischemic colonic complications have been reported in some patients treated with neostigmine, although these are rare 7.