Drug |
Use in GI disease |
Mechanism of action |
Common or significant adverse events |
Data for use in SSc GI disease |
Metoclopramide |
Esophageal dysmotility, hypotensive LES, gastroparesis, small bowel dysmotility |
Dopamine 2 receptor antagonist, 5HT4 agonist, weak 5HT3 antagonist |
Dyskinesia and acute dystonia |
Case series [28–30] |
Domperidone |
Esophageal dysmotility, hypotensive LES, gastroparesis |
Dopamine 2 antagonist |
Cardiac arrhythmia (QT prolongation), hyperprolactinemia |
RCT; open-label trial [22,31] |
Pyridostigmine |
Esophageal dysmotility, gastroparesis, small bowel and large bowel dysmotility |
Acetylcholinesterase inhibitor |
Abdominal pain and diarrhea |
Case series [27] |
Bethanechol |
Esophageal dysmotility, |
Parasympathetic choline carbamate that selectively stimulates muscarinic receptors |
Abdominal pain and diarrhea |
None |
Buspirone |
Esophageal dysmotility, hypotensive LES |
5HT1 receptor agonist; preferential full agonist of presynaptic 5HT1A receptors which are inhibitor autoreceptors and a partial agonist of postsynaptic 5HT1A |
Dizziness, drowsiness, nausea |
Open label trial [23,31] |
Sildenafil |
Hypotensive LES, colonic dysmotility |
Phosphodiesterase inhibitor |
Headache, lightheadedness, dizziness |
None |
Cisapride |
Esophageal dysmotility, gastroparesis, small bowel dysmotility |
Serotonin 5HT4 receptor agonist; indirectly acts as a parasympathomimetic |
Cardiac arrhythmia, headache, rash, abdominal cramps, diarrhea, |
Double-blind, placebo-controlled trial; case series [32–35] |
Prucalopride |
Large bowel dysmotility |
Selective high affinity 5HT4 receptor agonist |
Headache, nausea, abdominal pain, diarrhea |
Randomized cross-over study, case series [26,36] |
IVIG |
Gastroparesis |
May inhibit pathogenic antibodies to M3R receptors |
Aseptic meningitis |
Case series [24,25,37–40] |
Remorelin |
Gastroparesis |
Ghrelin agonist |
Flushing, upset stomach, nausea, fatigue |
None |
Octreotide |
Small bowel dysmotility |
Somatostatin mimic |
Arrhythmia, tachyphylaxis, hyperglycemia, dizziness, abdominal pain, diarrhea, flatulence |
RCT; case series [40,41] |
Neostigmine |
Small/large bowel dysmotility |
Anticholinesterase agent |
Arrhythmia, dizziness, diarrhea, dysphagia, nausea, crams, salivation, lacrimation, bronchospasm |
Randomized placebo crossover study; case series [42,43] |
Linaclotide |
Colonic dysmotility |
Guanylate cyclase 2C agonist on intestinal epithelial cells |
Diarrhea, abdominal pain flatulence, URI |
None |
Plecanatide |
Colonic dysmotility |
Activates guanylate cyclase C on intestinal endothelial cells |
Dizziness, diarrhea, abdominal distention |
None |
Lubiprostone |
Colonic dysmotility |
Activates CIC-2 chloride channels in GI epithelial cells |
Headache, nausea, diarrhea |
None |
Misoprostol |
Colonic dysmotility |
Prostaglandin analogue |
Diarrhea, abdominal pain, headache |
None |
Colchicine |
Colonic dysmotility |
Inhibitors microtubule polymerization; |
Diarrhea, nausea, vomiting |
None |
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