Gastroparesis: MANAGEMENT OF GASTROPARESIS ASSOCIATED WITH GASTROINTESTINAL SYMPTOMS Part 2

GastroparesisThe use of prokinetic drugs (cisapride, domperidone, metoclopramide and erythromycin) is the mainstay of therapy, and most patients require drug treatment. In general, these drugs all provide dose-related improvements in gastric emptying, although their mechanisms of action differ (Table 2). The response to prokinetic therapy tends to be greater when gastric emptying is more delayed. Because comparisons among these drugs are limited, it is difficult to give confident therapeutic recommendations. With the possible exception of erythromycin, all of these drugs have been shown to improve symptoms and quality of life. There is some evidence that tolerance may develop to the gastrokinetic effects of metoclopramide and domperidone. The mechanical effects of prokinetic drugs that are responsible for faster gastric emptying are poorly defined; the dominant effect is likely related to a change in the organization of antroduodenal contractions to an expulsive pattern. The response to prokinetic therapy is variable, and there is evidence that patients with myopathic and neuropathic disorders due to defective extrinsic neural innervation may respond less favourably. Best quality drugs are waiting – buy levaquin 500 mg to spend less time and money.

TABLE 2
Prokinetic drugs used in the treatment of gastroparesis

Drug Mechanism of action Oral dose (mg)
Cisapride 5-HT4 receptor agonist 10-20 tid
Domperidone Dopamine D2 receptor antagonist 10-30 qid
Metoclopramide 5-HT4 receptor agonist, D2 antagonist 10 qid
Erythromycin Motilin receptor agonist 250-500 tid

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