From the Research
Metoclopramide (Reglan) is generally considered the first-line therapy for managing gastroparesis in the hospital setting due to its prokinetic effects that directly address delayed gastric emptying, despite the potential risks of extrapyramidal symptoms and tardive dyskinesia with prolonged use 1. The typical dosing of metoclopramide is 10 mg IV or orally four times daily, 30 minutes before meals and at bedtime. Some key points to consider when choosing between metoclopramide and haloperidol include:
- Metoclopramide's prokinetic effects, which directly address delayed gastric emptying
- Haloperidol's lack of FDA approval for gastroparesis and its primary use as an antipsychotic
- The potential risks of extrapyramidal symptoms and tardive dyskinesia with prolonged use of metoclopramide
- The potential benefits of haloperidol in patients with anxiety or agitation accompanying their nausea
- The importance of individualizing treatment based on patient characteristics, comorbidities, and symptom presentation 2, 3. It's also worth noting that metoclopramide is the only medication approved by the FDA for the treatment of diabetic gastroparesis, and it has been shown to be effective in improving symptoms and gastric emptying in several studies 4, 5.