From the Guidelines
NSAIDs are contraindicated in patients with gastroparesis due to their potential to worsen gastrointestinal symptoms and increase complications. The use of NSAIDs, such as ibuprofen, naproxen, and diclofenac, can delay gastric emptying further and irritate the stomach lining, potentially exacerbating the already impaired gastric motility in gastroparesis 1. These medications can also increase the risk of developing gastric ulcers, bleeding, and perforation, which are particularly concerning in patients whose stomachs already empty slowly.
Some key points to consider when managing patients with gastroparesis include:
- Withdrawing drugs with adverse effects on gastrointestinal motility, including opioids, anticholinergics, and GLP-1 RAs, may improve intestinal motility 1
- The use of metoclopramide, a prokinetic agent, is approved by the FDA for the treatment of gastroparesis, but its use is recommended to be limited to severe cases that are unresponsive to other therapies due to the risk of serious adverse effects 1
- For pain management in gastroparesis patients, acetaminophen (Tylenol) is typically a safer alternative as it doesn't affect gastric motility or irritate the stomach lining 1
- If pain control requires something stronger, consultation with a healthcare provider is recommended to discuss options like carefully monitored low-dose opioids or adjuvant pain medications
The concern with NSAIDs stems from their mechanism of action - they inhibit prostaglandin synthesis, which normally helps protect the gastric mucosa and promotes normal gastric motility 1. Without these protective prostaglandins, gastroparesis symptoms may worsen and gastric damage becomes more likely. Therefore, it is recommended to avoid the use of NSAIDs in patients with gastroparesis and instead opt for alternative pain management options.
From the Research
NSAIDs and Gastroparesis
- There is no direct evidence in the provided studies that NSAIDs are contraindicated with gastroparesis 2, 3, 4, 5, 6.
- However, it is known that NSAIDs can cause gastrointestinal side effects, such as nausea, vomiting, and abdominal pain, which are also symptoms of gastroparesis.
- The studies focus on the treatment and management of gastroparesis, including prokinetic agents, antiemetic agents, and other medications, but do not specifically mention NSAIDs as a contraindication 2, 3, 4, 5, 6.
- It is essential to consider the potential interactions between NSAIDs and other medications used to treat gastroparesis, as well as the individual patient's medical history and condition, when making treatment decisions 2.
Treatment of Gastroparesis
- The treatment of gastroparesis typically involves a combination of dietary modifications, prokinetic agents, and antiemetic agents 3, 6.
- Prokinetic agents, such as metoclopramide and domperidone, are commonly used to improve gastric emptying and relieve symptoms 2, 3, 4.
- Antiemetic agents, such as promethazine and ondansetron, may be used to reduce nausea and vomiting 2, 3.
- Other treatment options, such as gastric electrical stimulation and intrapyloric botulinum toxin injections, may be considered for patients who are refractory to pharmacologic treatment 3, 6.