From the Guidelines
I strongly recommend scheduling an appointment with your healthcare provider to discuss restarting metoclopramide for your digestive symptoms, as it is the only FDA-approved medication for gastroparesis and has been shown to improve symptoms and gastric emptying 1. While you mention having some medication left, it's crucial to have a current evaluation before resuming any prescription medication. Your symptoms of reflux, sinus pressure, throat hoarseness, abdominal pain, and constipation could indicate recurrence of delayed gastric emptying, but could also represent other conditions that need proper assessment. If metoclopramide worked well previously, your doctor might prescribe it again, typically at 5-10mg taken 30 minutes before meals and at bedtime, as recommended in the AGA clinical practice update on management of medically refractory gastroparesis 1. Some key points to consider when taking metoclopramide include:
- It works by increasing stomach contractions and speeding up stomach emptying, which can reduce reflux symptoms
- It carries risks including neurological side effects with prolonged use, so medical supervision is essential
- Self-medicating with leftover prescription medication isn't recommended as your condition may require different treatment now While waiting for your appointment, you can try dietary modifications like:
- Eating smaller, more frequent meals
- Avoiding fatty foods
- Staying upright after eating
- Limiting alcohol, caffeine, and spicy foods These changes can help alleviate symptoms and are recommended as part of the management of medically refractory gastroparesis 1.
From the FDA Drug Label
For the Relief of Symptoms Associated with Diabetic Gastroparesis (Diabetic Gastric Stasis) If only the earliest manifestations of diabetic gastric stasis are present, oral administration of metoclopramide may be initiated.
- Key consideration: The patient is experiencing symptoms of gastrointestinal reflux and constipation, which may be related to delayed stomach emptying.
- Clinical decision: Given the patient's history of responding to metoclopramide and the presence of symptoms that may indicate delayed stomach emptying, reinitiating metoclopramide therapy may be considered.
- Important note: The physician should make a thorough assessment of the risks and benefits prior to prescribing further metoclopramide treatment 2.
From the Research
Symptoms and Treatment
- The symptoms described, such as sinus pressure, burning sensation in sinuses, throat hoarseness, pain in upper abdomen, constipation, and gastritis, are consistent with gastrointestinal reflux and delayed stomach emptying 3, 4.
- Metoclopramide has been shown to be effective in treating delayed gastric emptying and gastrointestinal reflux symptoms in various studies 3, 4, 5, 6.
Effectiveness of Metoclopramide
- A study published in 1983 found that metoclopramide improved gastric emptying in patients with gastroesophageal reflux disease, regardless of their baseline gastric emptying status 3.
- Another study published in 1998 found that metoclopramide improved symptoms and gastric emptying in patients with Fabry's disease, a condition that can cause delayed gastric emptying 4.
- A review of metoclopramide published in 1981 highlighted its ability to enhance gastric emptying without stimulating gastric acid secretions, making it a useful treatment for conditions like diabetic gastroparesis 5.
Comparison with Other Treatments
- A study published in 2010 compared the use of metoclopramide with other treatments, including erythromycin and bedside nasointestinal tube placement, and found that metoclopramide was effective in treating delayed gastric emptying in critically ill patients 7.
- A randomized, double-blind study published in 1979 found that metoclopramide was more effective than placebo in treating symptoms of delayed gastric emptying 6.