From the Research
For patients with gastroparesis seeking weight loss, metoclopramide (10mg before meals) is the recommended first-line pharmacological approach as it addresses both conditions simultaneously, according to the most recent and highest quality study available 1. This medication improves gastric emptying while potentially supporting weight management by reducing symptoms that lead to irregular eating patterns. Some key points to consider when managing weight loss in patients with gastroparesis include:
- Initiating weight loss medication at low doses with careful monitoring for worsening gastroparesis symptoms
- Implementing dietary modifications, such as small, frequent, low-fat, low-fiber meals, alongside pharmacotherapy
- Regular follow-up to assess both gastroparesis symptoms and weight loss progress, with medication adjustments made accordingly Other options, such as semaglutide (Wegovy) at gradually increasing doses up to 2.4mg weekly subcutaneously, may also be considered, as they promote weight loss while potentially improving gastric emptying in some patients, though they should be used cautiously as GLP-1 agonists can sometimes worsen gastroparesis symptoms 1. Erythromycin (250mg before meals) may be considered as it stimulates gastric motility, potentially helping with both gastroparesis management and creating more regular eating patterns conducive to weight control 1. The approach should be individualized based on gastroparesis severity, and regular monitoring is essential to ensure that the chosen treatment does not exacerbate symptoms, as highlighted in recent studies 2, 3.