Metoclopramide in the Treatment of Diabetic Gastroparesis

Allen Lee; Braden Kuo

Expert Rev Endocrinol Metab. 2010;5(5):653-662.

Indications

Metoclopramide is used for the symptomatic treatment of post-operative or chemotherapy-induced nausea and vomiting, gastroesophageal reflux disease and gastroparesis. Metoclopramide is generally started at a dose of 5–10 mg orally, 30 min before meals and at bedtime. The dose can be increased up to 20 mg four-times daily if necessary, but may be limited by side effects.

Metoclopramide is available in a liquid preparation for patients for whom there is concern that oral tablets may not be adequately emptied from the stomach to allow sufficient absorption of the medication. Recently, an orally disintegrating sublingual formulation of metoclopramide has been developed and is available for use. An intranasal formulation of metoclopramide is also available and may have advantages including rapid-onset of delivery and circumvention of first-pass elimination compared with oral formulations. Bioavailability was recently demonstrated to be increased with the intranasal compared with the oral formulation of metoclopramide (54.61 vs 40.67%).^[38]

Subcutaneous injections of metoclopramide are also available and have been demonstrated to improve symptoms in patients with more refractory symptoms.^[39] Finally, intravenous metoclopramide is often used for patients who are hospitalized with exacerbations of gastroparesis.

1 2 3 4 5 6 7 8 9 10

Next Section

Cite this: Metoclopramide in the Treatment of Diabetic Gastroparesis - Medscape - Sep 01, 2010.

Table 1. Risk of tardive dyskinesia with metoclopramide.
Study (year)	Study design	Number studied	Result	Estimated prevalence	Ref.
Wilholm et al. (1984)	Scandinavian prescription database, 1977–1981	11 million Rx of metoclopramide	37 reports of EPS with 11 TD casesAll females, mean age of 76 years	One in 2000–28,000 patient-years, one in 17,800 perscriptions	^[71]
Bateman et al. (1985)	UK prescription database, 1967–1982	15.9 million Rx of metoclopramide	479 reports of EPS, four with TD	One in ~35,000 prescriptions, significantly higher risk in females, especially those 12–19 years old	^[64]
Sewell et al.(1992)	Analysis of 67 case reports of metaclopramide-induced TD	52 patients on at least 30 days of metoclopramide	Mean age of 70 ± 19 years, 3:1 female predominance and Rx duration of 20 ± 15 months; 47% TD cases persisted at 6 months despite discontinuation of metoclopramide	Not estimable	^[74]
Ganzini et al. (1993)	VA study using exposed/unexposed design, matched for age, gender, diabetes and comorbidities	51 chronic Rx of metoclopramide; 51 unexposed	Mean age of 63.9 ± 10.8 years, male predominant, duration of treatment 2.6 ± 2.0 years	29% TD in metoclopramide Rx vs 17.6% in nonusers (p = 0.08)	^[65]
Sewell et al. (1994)	VA cross-sectional study	51 patients with metoclopramide-associated TD; 35 controls matched for age, race, gender and diabetes	Duration of metoclopramide treatment of at least 30 days	27% TD in metoclopramide Rx vs 12% nonusers (p = 0.08) Patients on metoclopramide and diabetic more likely to develop TD (p = 0.05)	^[73]
Shafter et al. (2004)	International metoclopramide adverse event reports and US drug-use data	87 case reports	Mean duration of Rx of 753 ± 951 days; 37% used concomitant drugs, 18% had comorbid diseases with TD risk	Not estimableIncreased use of metoclopramide afer cisapride withdrawal	^[16]
Kenney et al. (2008)	Observational study in a tertiary-care movement-disorder clinic	434 patients referred for TD	Metoclopramide accounted for 39.4% of TD, the second-leading cause of TD after haloperidol	Not estimable	^[72]

EPS: Extrapyramidal side effects; TD: Tardive dyskinesia; VA: Veterans administration.
Adapted from ^{[14,16,64,65,71–74]}.

Box 1. Effects of metoclopramide.
Gastric motility D₂receptor antagonist Stimulation 5-HT₄receptors Muscarinic receptor antagonist Symptoms of gastroparesis Promotes gastric emptying Anti-emetic effects via central pathways Normalization of gastric slow wave dysrhythmias Modulates visceral hypersensitivity

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....

Metoclopramide in the Treatment of Diabetic Gastroparesis

Indications

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar

Key Issues

Comments

Email This

Feedback