Can I use droperidol and Reglan (metoclopramide) for treating gastroparesis?

From the Guidelines

Droperidol and Reglan (metoclopramide) should not be used together for gastroparesis due to overlapping side effects and increased risk of adverse effects without additional benefit. Metoclopramide is a first-line medication for gastroparesis, usually started at 5-10 mg orally three to four times daily before meals and at bedtime 1. Droperidol is less commonly used for gastroparesis in outpatient settings and is typically reserved for acute situations in hospital settings. Both medications work by blocking dopamine receptors, which helps increase gastric emptying, but this mechanism also means they can cause similar neurological side effects like extrapyramidal symptoms (muscle spasms, tremors) and potentially QT prolongation.

Key Considerations

• Metoclopramide is the only FDA-approved medication for gastroparesis, but its use beyond 12 weeks is no longer recommended due to the risk of serious adverse effects 1.
• Alternative options like domperidone (where available), erythromycin, or non-pharmacological approaches might be more appropriate than adding droperidol if metoclopramide alone is ineffective 1.
• The management of gastroparesis should prioritize the patient's specific symptoms and medical history, with careful monitoring and individualized dosing of medications 1.

Recommendations

• Consult with a healthcare provider before starting or combining these medications.
• Carefully weigh the benefits and risks of using metoclopramide beyond 12 weeks.
• Consider alternative treatment options for gastroparesis, including dietary changes, domperidone, erythromycin, or non-pharmacological approaches.

From the Research

Treatment of Gastroparesis

• Gastroparesis is a disorder characterized by delayed gastric emptying due to chronic abnormal gastric motility 2.
• The treatment of gastroparesis often entails the co-administration of several classes of pharmacological agents, including prokinetic agents such as metoclopramide and domperidone, and antiemetic agents such as promethazine and ondansetron 2.

Use of Metoclopramide for Gastroparesis

• Metoclopramide is primarily a dopamine receptor antagonist, with 5HT3 receptor antagonist and 5HT4 receptor agonist activity, and is used as an antiemetic and gastroprokinetic 3.
• 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 4.
• Metoclopramide is approved for the treatment of symptoms associated with diabetic gastroparesis, and has been used in the treatment of vomiting of various etiologies 4.

Combination Therapy with Droperidol and Reglan (Metoclopramide)

• There is limited information available on the specific combination of droperidol and Reglan (metoclopramide) for the treatment of gastroparesis.
• However, metoclopramide should not be given in combination with certain medications, such as MAO inhibitors, tricyclic antidepressants, sympathomimetic amines, or to patients with pheochromocytoma, GI hemorrhage, obstruction, or perforation 4.
• The use of metoclopramide in combination with other medications, including droperidol, should be approached with caution and careful consideration of potential drug-drug interactions 2.

Safety and Efficacy of Metoclopramide

• Metoclopramide carries a black box warning for use >12 weeks due to the risk of tardive dyskinesia (TD), a movement disorder that may be irreversible 5.
• The risk of TD from metoclopramide is low, in the range of 0.1% per 1000 patient years, but high-risk groups include elderly females, diabetics, patients with liver or kidney failure, and patients with concomitant antipsychotic drug therapy 3.
• Metoclopramide has a favorable adverse-effect profile, but side effects can include drowsiness, GI disturbances, extrapyramidal reactions, and increased lactation 4.