Medications for Gastroparesis

Gastroparesis is a debilitating stomach disease for which there is no cure. However, there are a few medications for gastroparesis that may help mask symptoms and make life more manageable.

Despite the debilitating nature of the disorder, gastroparesis is sorely lacking in available resources for patients in the way of education and awareness. So, we (successfully) petitioned to make August the official gastroparesis awareness month. In our efforts to raise both funds for research and awareness this month, we also wanted to develop some resources that we felt would be an asset to someone who is newly diagnosed.

CDHF worked together with gastroparesis patient and advocate; Jennifer Ouellette, to put together a list of medications for gastroparesis. This detailed and comprehensive list will walk you through each medication, its uses, the potential side effects, and risks, along with some insights from Jennifer herself.

If you’re newly diagnosed and would like a deeper look into what medications for gastroparesis might make an appearance in your treatment plan, feel free to take a read or share with your doctor.

This list of medications for gastroparesis is meant for general information only and is not intended to replace any advice you may have already received from your healthcare practitioner.

12 Medications for Gastroparesis:

Domperidone (motilium)

Is one of the most commonly prescribed medications for gastroparesis, and usually the first treatment option that is offered. It does pose cardiac risk so it is recommended to have an electrocardiogram before starting and to continue to have cardiac activity monitored while on the medication. It can be used long term but you should be monitored by a doctor while on the medication. It works as an antiemetic and as a gastric prokinetic. It is supposed to help with nausea and vomiting as well as help speed up the gastric emptying time. This is the drug that I was on for 4 times a day for almost 10 years before it stopped working. It kept a lot of my symptoms calm with an occasional flare-up happening every once in a while.

Common Side Effects 

• breast pain
• diarrhea
• dry mouth
• headache
• migraine
• nausea
• rash

Rare but more serious side effects:

• breast milk flowing from the nipple
• fast, pounding, or racing heartbeat or pulse
• menstrual irregularities
• swelling of the breast (males)

Do not take domperidone if you:

• are allergic to domperidone or any ingredients of the medication
• are taking the medication ketoconazole
• are taking medications which cause QT prolongation
• have bleeding in the stomach or intestines
• have a blockage in the stomach or intestines
• have breaks in the lining of the stomach or intestines
• have a prolactinoma (a tumour of the pituitary gland)
• have uncorrected levels of potassium, magnesium, or calcium in your blood
• have cardiac disease (e.g., heart failure)
• have QT prolongation (a type of irregular heartbeat)
• have moderate or severe liver impairment

Metoclopramide (also known as Maxeran or Reglan or Metonia)

Despite some troublesome side effects, Metoclopramide is also one of the more commonly prescribed medications for Gastroparesis. Like Domperidone, it is supposed to help relief nausea, vomiting and also help with speeding up gastric emptying times and also help with reflux. It poses a risk of developing serious side effects such as Tardive Dyskenesia and Neuroleptic malignant syndrome. I was on the liquid form of this medication and started developing neurological twitches that could have turned into Tardive Dyskensia and been permanent. Thankfully for me, they went away after stopping the medication but that is unfortunately not the case for everyone.

Common Side Effects

• diarrhea (with high doses)
• dizziness
• drowsiness
• fatigue
• restlessness or difficulty sleeping

More serious side effects to watch for:

• chills
• difficulty speaking or swallowing
• dizziness or fainting
• fast or irregular heartbeat
• fever
• a general feeling of tiredness or weakness
• headache (severe or continuing)
• inability to move eyes
• increase in blood pressure
• lip smacking or puckering
• loss of balance control
• mask-like face
• muscle spasms of face, neck, and back
• puffing of cheeks
• rapid or worm-like movements of the tongue
• shuffling walk
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• sore throat
• stiffness of arms or legs
• tic-like or twitching movements
• trembling and shaking of hands and fingers
• twisting movements of the body
• uncontrolled chewing movements
• uncontrolled movements of arms and legs
• unusual eye movements
• a weakness of arms and legs

Do not take metoclopramide if you:

• are allergic to metoclopramide or any of the ingredients of this medication
• have a condition where faster passage of materials through the stomach might be dangerous (e.g., in cases of stomach bleeding, or breaks in the stomach lining)
• Metoclopramide should not be given to children less than one year of age.

Erythromycin

The same antibiotic that we use to treat bacterial infections also has a use in treating Gastroparesis. It is typically used at a lower dosage, not the same dosing used for antibiotic treatment with the drug.  I was told it shouldn’t be used longer than 4 weeks without a break because of side effect risks. It works by helping to stimulate the receptors that assist in making GI contractions and that helps increase motility in the GI tract. This is one of the medications for gastroparesis that was not effective for me when I tried it but I have heard some people have success with it short term.

Common Side Effects:

• abdominal or stomach cramping and discomfort
• diarrhea
• nausea or vomiting

Rare more serious side effects:

• confusion
• continued diarrhea even after you have finished taking this medication
• irregular or fast heartbeat
• hallucinations
• loss of hearing (temporary)
• nausea or vomiting (severe)
• ringing in the ear
• seizures
• skin rash, redness, or itching
• stomach pain (severe)
• symptoms of liver damage (e.g., yellow skin or eyes, abdominal pain, dark urine, clay-colored stools, loss of appetite, nausea, and vomiting, or itching)
• unusual tiredness or weakness
• vertigo

Erythromycin should not be taken by anyone who:

• is allergic to erythromycin, or to any of the ingredients of the medication
• is allergic to clarithromycin or other macrolide antibacterial agents
• is pregnant
• has preexisting liver disease or dysfunction

Cisapride (Propulsid)

This is one of the medications for gastroparesis that has been banned in many countries. It is still available to my knowledge in Canada through Health Canada Special Access program. It is severely restricted because of the risk of rare but serious cardiac events associated with the drug.  Cisapride works as a gastric prokinetic agent increasing the motility in the GI tract.

Common Side Effects

• Constipation
• Diarrhea
• Stomach Cramps
• Drowsiness
• Nausea
• Headaches
• Low Energy

Rare serious Side effects

• Bronchospasm
• Complete Stoppage Of The Heart
• Confused
• Depression
• Giant Hives
• Hallucination
• Prolonged QT Interval On EKG
• Seizures
• Very Rapid Heartbeat – Torsades De Pointes
• Discharge Of Milk In Men Or Women When Not Breastfeeding
• Enlarged Breasts
• Hives
• Increased Prolactin In The Blood
• Problems With Bladder Control

Prucalopride (Resotran, Resolor)

This is one of the medications for gastroparesis that was part of the clinical trials held in Calgary. It is primarily used as a drug to help treat chronic constipation in women. It has been used by a lot of people in our Facebook support group, including myself. Some people have responded very well to Resotran. It worked great for me for about 6-7 months and then it stopped working. It helped speed up emptying times for me but the trade-off was a great deal of diarrhea.

Most common side effects:

• abdominal pain
• back pain
• diarrhea
• dizziness
• enlargement of abdomen or stomach
• fatigue
• headache
• heartburn
• gas
• loss of appetite
• nausea
• sinusitis
• stomach upset
• tiredness
• vomiting

Rare but serious side effects:

• abnormal heart rhythms (such as fast or slow heart rate, palpitations)
• chest pain
• migraine
• pounding, rapid heartbeat (palpitations)

Do not take this medication if you:

• are allergic to prucalopride or any ingredients of this medication
• have kidney disease that requires dialysis
• have serious problems with your digestive system, such as a tear in the wall of the digestive system, a blockage in the digestive system, or inflammatory disease of the intestine such as Crohn’s disease or ulcerative colitis
• have galactose intolerance or glucose malabsorption (a rare hereditary disease)

Ondasetron (Zofran)

This is probably one of the more common antiemetic medications for gastroparesis that is prescribed. It is a drug that is used most often to treat nausea and vomiting associated with chemo or radiation in cancer patients. Many Gastroparesis patients including myself (until they no longer worked) find that this drug works well to help with nausea.

Common Side effects

• constipation
• flushing or feeling warm
• low blood pressure
• unusual tiredness or weakness

Rare more serious side effects

• blurred vision
• difficulty moving or abnormal body movement
• dizziness
• pain, redness, or burning at place of injection
• rapid pounding heartbeat

Do not take this medication if you:

• are allergic to ondansetron or any ingredients of the medication
• are taking the medication apomorphine

Promethazine (Phenergan)

It is an antihistamine used to treat allergies, nausea, and trouble sleeping. They use this medication a lot to help women with morning sickness during pregnancy. I have used it a few times for nausea and it works decently.

Common Side Effects:

• drowsiness, dizziness;
• ringing in your ears;
• double vision;
• feeling nervous;
• dry mouth; or
• tired feeling, sleep problems (insomnia).

Rare severe Side effects:

• severe drowsiness, weak or shallow breathing;
• a light-headed feeling, like you, might pass out;
• confusion, agitation, hallucinations, nightmares;
• seizure (convulsions);
• fast or slow heartbeats;
• jaundice (yellowing of the skin or eyes);
• uncontrolled muscle movements in your face (chewing, lip-smacking, frowning, tongue movement, blinking or eye movement);
• easy bruising or bleeding (nosebleeds, bleeding gums);
• sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, red or swollen gums, trouble swallowing; or
• very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Relamorelin

It is a new drug being trialed currently with diabetic Gastroparesis patients here in Canada. As I have idiopathic Gastroparesis I have not had a chance to trial this drug as of yet.

https://ucalgary.ca/motility/current-research/treatment-diabetic-gastroparesis-new-clinical-trial

I don’t have a list of side effects yet as they are still testing the drug. The studies have been promising. Showing so far that there have been no cardiac or neurological side effects which would mean it could potentially be a safer option than some of the other medications out there currently.

Botox injections – (not covered in every province)

This seems to be hit or miss among patients who have tried it. My specialist said for my personal case my Gastroparesis it is too severe and it wouldn’t be worth it.  As I am not incredibly familiar with how it all works, so here is the official description of its use in cases of gastroparesis:

“While the patient is sedated, the physician will advance a scope through the esophagus, stomach, and the pyloric sphincter. Botox is injected into the pyloric sphincter in an effort to relax that muscle, enabling food to empty from the stomach more easily. It takes approximately 15-30 minutes.

The effects of the botox may be felt immediately or may take some time to begin working. Complications from the procedure include nausea and vomiting from sedatives. Although rare, some report bleeding, perforation of the esophagus, fever, or severe vomiting.

Botox injections are not a permanent solution and usually last no more than 6 months. Repeat injections do not always produce the same results.”

Linaclotide (Constella)

It is used to treat IBS-C and to treat chronic (long-term) constipation. It seems to be commonly prescribed for Gastroparesis patients who experience chronic constipation as well. It is usually my go-to medication when I am having issues with constipation and while it causes a bit more pain and bloating it does help with relieving constipation.

Common Side Effects:

• loating (swelling or feeling of fullness in your abdomen)
• diarrhea
• nausea
• passing gas
• vomiting

Rare Side effects: 

• new or worsening abdominal pain
• severe diarrhea (persistent watery stools)

Nabilone (synthetic cannabinoids)

Used to treat severe nausea. I know some people in the group have tried this as they can get their insurance to cover the pill form of synthetic cannabinoids but no coverage for actual cannabis. I cannot speak personally about this one as I use actual Medical Cannabis to treat my symptoms.

More Common Side effects:

• blurred vision or any changes in vision
• clumsiness or unsteadiness
• confusion
• dizziness or light-headedness, especially when rising from a lying or sitting position (more common with high doses)
• drowsiness
• dry mouth
• headachee
• loss of appetite
• loss of muscular coordination
• nightmares

Rare more serious side effects: 

• changes in mood (including a false sense of well-being)
• confusion
• convulsions (seizures)
• delusions
• depression
• dizziness or fainting
• fast or pounding heartbeat
• hallucinations
• nervousness or anxiety
• sensation disturbance (unusual sensations or changes in sensations)
• unusual tiredness or weakness (severe)

Medical Cannabis for Gastroparesis

Is one of the most effective medications for gastroparesis, as far as managing symptoms go. Everyone is going to be different and Cannabis may or may not work for everyone.  Finding strains that have proper terpenes to help digestive issues, like Limonene is important when trying to find the best strains to help. This study may be of interest as it is newer research. Hopefully, more research and some clinical trials can happen soon!

With the help of people like YOU, we can raise money and awareness for gastroparesis. Hopefully, in time, new, more effective medications for gastroparesis can be found. Perhaps even a cure!