Gastroparesis: That Gut Feeling (Part 3)
October 6, 2008
This week, we’ll wrap up the "gastroparesis series" and focus on other treatments, besides dietary changes, that can be effective. The type and extent of treatment of this diabetes complication varies from person to person and largely depends on the severity of symptoms.
Most people with gastroparesis will benefit from making changes, as discussed last week, in their eating habits and food choices, whether that means switching from eating three meals a day to six meals a day or cutting back on their fat and fiber intake. Other people may need more help, in the form of medication. Let’s look at some of the options.
Drug Management of Gastroparesis
Treating gastroparesis with medicine is certainly an option, but finding the right drug requires trial and error. Also, remember that drugs are not without side effects. Here are the meds commonly used for gastroparesis:
- Metoclopramide (brand names Reglan, Maxolon, Octamide): Metoclopramide acts on certain receptors in the gastrointestinal tract as well as the brain. This drug triggers stomach contractions to help empty the stomach. In addition, metoclopramide works on the part of the brain that controls nausea and vomiting, so it can provide relief from these symptoms, too. This med is typically taken about 30 minutes before meals and at bedtime. Side effects include agitation, facial twitching, fatigue, depression, and breast swelling. This drug can worsen symptoms of Parkinson disease. Metoclopramide is meant to be used in the short term, and any serious symptoms usually go away once the drug is stopped.
- Erythromycin: This medication is an antibiotic that binds to receptors in the stomach, helping to increase contractions and stomach emptying, similar to metoclopramide. While effective for some, it, too, isn’t meant to be taken long term, as people can develop a tolerance to it. Erythromycin may also cause cramps, nausea, and vomiting. This drug may be best used on an occasional basis or when symptoms of gastroparesis seem to be worsening.
- Cisapride (Propulsid): Cisapride binds to other types of receptors in the stomach, also helping to improve stomach emptying. Because it can lead to serious heart problems, this drug was removed from the market, although is once again available with some restrictions. Cisapride is taken 15 minutes before meals and at bedtime. Side effects include diarrhea, constipation, nausea, stuffy nose, and headache. This drug can interact with certain other drugs, such as antibiotics, antidepressants, and anti-arrhythmia meds, and shouldn’t be taken by people who have a history of heart problems, chest pain, kidney problems or breathing problems.
- Domperidone (Motilium): This drug is more widely used in other countries. Domperidone works in a manner similar to metoclopramide, enhancing stomach emptying. It’s taken 15 to 30 minutes before meals and at bedtime. Domperidone can also prevent nausea and vomiting. Side effects include dizziness, dry mouth, headache and nervousness. This drug should be used with caution in people with liver disease.
Researchers are looking at other drugs to help treat gastroparesis, including tegaserod (Zelnorm) and octreotide (Sandostatin), but no other medications have as yet been approved at this time. And still other drugs may be used to treat specific symptoms of gastroparesis, such nausea and heartburn.
There are other methods that may be used for treating gastroparesis, including the use of botulinum toxin injections (Botox) and electrical gastric stimulation, whereby a small device is implanted near the stomach wall that delivers electrical impulses. These impulses cause the stomach muscles to contract. Neither of these therapies is widely used, but some medical centers in the U.S. provide them.
If you or someone you care about has gastroparesis, you might check out G-PACT, a nonprofit organization founded by people who have gastroparesis. You can learn more about this condition, stay on top of treatments, and find physicians at www.g-pact.org.
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