From the Guidelines
Bentyl (dicyclomine) is not recommended as a first-line treatment for gastroparesis associated with GLP-1 receptor agonist medication side effects, as it may worsen gastroparesis by further slowing stomach emptying. According to the most recent evidence from 2024, treatment for diabetic gastroparesis may be challenging, and a low-fiber, low-fat eating plan provided in small frequent meals with a greater proportion of liquid calories may be useful 1. Withdrawing drugs with adverse effects on gastrointestinal motility, including opioids, anticholinergics, TCAs, GLP-1 RAs, and pramlintide, may also improve intestinal motility 1.
Some key points to consider when treating gastroparesis associated with GLP-1 receptor agonist medication side effects include:
- Metoclopramide, a prokinetic agent, is approved by the FDA for the treatment of gastroparesis, but its use is recommended only for severe cases that are unresponsive to other therapies due to the risk of serious adverse effects 1.
- Other treatment options include domperidone (available outside the U.S.) and erythromycin, which is only effective for short-term use due to tachyphylaxis 1.
- Gastric electrical stimulation using a surgically implantable device has received approval from the FDA, although its efficacy is variable and use is limited to individuals with severe symptoms that are refractory to other treatments 1.
It is essential to consult a healthcare provider before starting any medication for GLP-1-induced gastroparesis, as the appropriate approach depends on symptom severity, medical history, and whether dose reduction or discontinuation of the GLP-1 medication is necessary. The potential benefits and risks of each treatment option should be carefully considered, prioritizing the patient's morbidity, mortality, and quality of life as the primary outcome.
From the Research
Gastroparesis and GLP-1 Receptor Agonists
- Gastroparesis is a condition characterized by delayed gastric emptying without mechanical obstruction, often associated with diabetes and other conditions 2, 3.
- GLP-1 receptor agonists are therapeutics used to treat type 2 diabetes and obesity, but they can slow gastric emptying and motility of the small intestine, potentially leading to gastroparesis-like symptoms 4.
Treatment Options for Gastroparesis
- Current management for gastroparesis focuses on dietary and lifestyle changes, improved glycemic control, and limited medical therapies, including prokinetic and antiemetic medications 2, 3.
- Metoclopramide is the only FDA-approved medication for the treatment of gastroparesis, but it has limitations, such as decreased efficacy over time and increased risks for adverse events 2, 3.
- Other medications, such as relamorelin, a synthetic ghrelin analog, have shown promise in treating diabetic gastroparesis, but are still in clinical trial stages 5.
- Mirtazapine therapy has been used to help with weight loss and gastroparesis associated with systemic sclerosis, and may be beneficial for patients with similar conditions 6.
Bentyl (Dicyclomine) for Gastroparesis
- There is no direct evidence in the provided studies to support the use of Bentyl (dicyclomine) for treating gastroparesis associated with GLP-1 receptor agonist medication side effects.
- However, the use of prokinetic medications like erythromycin may be helpful in managing gastroparesis-like symptoms associated with GLP-1 receptor agonists 4.
GLP-1 Receptor Agonists and Gastroparesis
- GLP-1 receptor agonists can slow gastric emptying and motility of the small intestine, potentially leading to gastroparesis-like symptoms 4.
- The clinical consequences of delayed gastric emptying with GLP-1 receptor agonists and tirzepatide are still being studied, and well-justified recommendations for periprocedural management are compromised by limited evidence 4.