Prokinetics

Metoclopramide

• Improves gastric emptying by enhancing gastric antral contractions and decreasing postprandial fundus relaxation
• Doesn't have any impact on colon
• First-line for gastroparesis
• Side effects:
  • Anxiety
  • Restlessness
  • Depression
  • Hyperprolactinaemia
  • Prolonged QT
  • EPS including dystonia

Domperidone

• Likely efficacy for gastroparesis is similar to metoclopramide
• Increased risk of arrhythmias

Erythromycin

• Third-line for gastroparesis after metoclopramide and domperidone
• Motilin agonist
• Induces high-amplitude gastric propulsive contractions that increase gastric emptying, and stimulates fundic contractility
• Can be given as oral (40-250mg TDS) or IV (stronger effect)
• Should only give for 4 weeks at a time due to tolerance/tachyphylaxis

Cisapride

• Stimulates antral and duodenal motility and accelerates gastric emptying of solids and liquids
• Only used for patients that have failed all others, due to risk of cardiac arrhythmias