Gastroparesis treatment with Reglan (Metoclopramide)?

From the Guidelines

Gastroparesis treatment with Reglan (metoclopramide) is a commonly used approach, involving an initial dose of 5-10 mg administered orally or intravenously 30 minutes before meals and at bedtime, with a maximum daily dose of 40 mg 1.

Key Points

• The medication works by enhancing gastric motility and accelerating gastric emptying, providing relief from nausea, vomiting, and abdominal bloating associated with gastroparesis.
• Treatment duration is typically long-term, often requiring ongoing management to control symptoms.
• Metoclopramide is the only FDA approved medication for gastroparesis, with all other agents considered off-label use 1.

Dosage and Administration

• The recommended dose is 5-20 mg tid-qid, with a maximum daily dose of 40 mg 1.
• The medication should be administered 30 minutes before meals and at bedtime to maximize its effectiveness.

Important Considerations

• Metoclopramide can cause QT prolongation and ventricular tachycardia, especially at high doses, and should be used with caution in patients with cardiovascular disease 1.
• The medication can also cause central side effects, such as drowsiness and anxiety, especially at high doses 1.

Alternative Treatment Options

• Other medications, such as domperidone, ondansetron, and granisetron, may be used to treat nausea and vomiting associated with gastroparesis, but their effectiveness and safety have not been extensively studied 1.
• Gastric electrical stimulation and G-POEM may be considered for patients with refractory gastroparesis who have failed standard therapy 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. However, if severe symptoms are present, therapy should begin with Metoclopramide Injection (intramuscular or intravenous) Diabetic Gastroparesis (Diabetic Gastric Stasis) Metoclopramide Injection (metoclopramide hydrochloride, USP) is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis

Gastroparesis treatment with Reglan (Metoclopramide): Metoclopramide is indicated for the relief of symptoms associated with diabetic gastroparesis. The treatment should begin with intravenous or intramuscular administration if severe symptoms are present, and may be switched to oral administration once symptoms subside 2, 2.

• Key points:
  • Metoclopramide is indicated for diabetic gastroparesis treatment
  • Intravenous or intramuscular administration is recommended for severe symptoms
  • Oral administration may be initiated for mild symptoms or after symptoms subside with intravenous or intramuscular treatment

From the Research

Gastroparesis Treatment with Reglan (Metoclopramide)

• Metoclopramide is widely used to treat gastroparesis, increasing gastric emptying and inhibiting nausea and vomiting 3
• The drug has been shown to be effective in relieving symptoms of diabetic gastroparesis, including nausea, vomiting, anorexia, fullness, and bloating 4
• Metoclopramide's therapeutic effects are mediated through its prokinetic properties as well as centrally mediated antiemetic actions 4

Efficacy of Metoclopramide

• Studies have demonstrated the efficacy of metoclopramide in improving gastric emptying and relieving symptoms of gastroparesis 4, 5
• Metoclopramide has been shown to be effective in both oral and parenteral forms, with significant improvements in symptomology and gastric emptying 4, 5
• However, correlation between gastroparesis symptoms and rates of gastric emptying is poor, and individual improvements in gastric emptying after metoclopramide treatment could not be correlated with symptom change 3, 4

Comparison with Other Treatments

• Metoclopramide is one of several prokinetic agents used to treat gastroparesis, including domperidone and cisapride 6, 7
• While metoclopramide is currently the first-line agent for the management of gastroparesis, domperidone and cisapride may be useful alternatives in patients who are unresponsive to or cannot tolerate metoclopramide therapy 7
• Novel approaches to treatment of nausea, including the use of ghrelin receptor agonists, are also being explored 3