Gastroparesis medications & treatments
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Gastroparesis is a disease in which the stomach’s emptying function is slowed or not working. You may hear your doctor call it delayed gastric emptying. According to a 2021 study published in Gastroenterology, it is estimated that gastroparesis occurs in 268 out of 100,000 American adults. Gastroparesis can slow down digestion, which may lead to numerous symptoms, complications, and reduced quality of life. Gastroparesis is typically a long-term condition that can affect your digestion and cause issues with your nutrition as well as your blood sugar levels.
What is gastroparesis?
If you have gastroparesis, muscles and damaged nerves, including your vagus nerve don’t work properly — slowing down the passage of food through your digestive system. In most cases, the cause of gastroparesis is unknown but the most common cause is diabetes. Other causes can include:
- Injury to the vagus nerve from surgery to your esophagus, stomach, or small intestine.
- Medicines such as narcotics, antidepressants, and high blood pressure meds that can slow the motility of your stomach.
- Low thyroid levels (hypothyroidism)
- Parkinson’s disease
- Viral infections
- Amyloidosis (deposits of protein fibers in tissues and organs)
- Scleroderma (a connective tissue disorder)
This slowing of food moving through your digestive tract can cause complications such as:
- Dehydration, from repeated vomiting.
- The undigested food can harden into a solid mass called a bezoar that can cause a blockage that keeps food from passing into your small intestine.
- Malnutrition and electrolyte imbalances due to poor absorption.
- Uncontrolled blood sugars.
- Bacteria from food sitting in the stomach and fermenting.
How is gastroparesis diagnosed?
Your healthcare professional will ask about your past medical history and current, possible gastroparesis symptoms.
The most common symptoms of gastroparesis include:
- Heartburn or GERD (gastroesophageal reflux disease)
- Abdominal bloating or abdominal pain
- Feeling of fullness after just a few bites of food (early satiety)
- Changes in blood sugar levels
- Poor appetite
- Weight loss and malnutrition
They will also give you a physical exam as well as use tests to confirm the diagnosis of gastroparesis. These tests may include:
- Blood tests. These will check for signs of malnutrition, infection, dehydration, and changes in your blood sugar levels.
- Gastric emptying study. In this test, also called gastric scintigraphy, you are given a small meal that contains trace amounts of radioactive material. They will then scan your abdomen to track how fast your stomach empties after a meal. If after 4 hours you still have more than 10% of food in your stomach, you are diagnosed with gastroparesis.
- Breath test. For this test, you eat a meal that contains a substance that is absorbed and can be detected in your breath. They will then measure the amount of this substance in your breath over a few hours to measure how fast food passes through your stomach.
- Upper GI (gastrointestinal) endoscopy. Your doctor will use a thin tube called an endoscope to look at your esophagus, stomach, and duodenum.
- Barium swallow. You will swallow liquid barium, which will then coat the top part of your digestive tract which can then be examined on an X-ray.
- SmartPill. In this test, you swallow a small electronic device that can be monitored to determine how fast food moves through your digestive system.
What are some treatment options for gastroparesis?
In most cases, the best treatment is managing the underlying condition that is causing gastroparesis. For example, if you have diabetic gastroparesis, your doctor will work on controlling your blood glucose levels. When the cause is not known (idiopathic gastroparesis), your doctor will try to manage any symptoms and complications.
These treatments can include:
- Dietary changes. This is the first-line treatment for gastroparesis and can help manage symptoms and correct any nutritional deficiencies. Your doctor or dietitian may suggest eating small, nutritious meals throughout the day. In severe cases of gastroparesis, you may be put on a total liquid diet. You may also be told to reduce the amount of fatty and high-fiber foods you eat. These foods can slow your digestion. You will want to drink plenty of water or liquids but avoid carbonated beverages and alcohol.
- Medications. These can include meds such as Reglan (metoclopramide) and erythromycin that stimulate the stomach muscles to help improve gastric emptying. You might also get some benefits from prescription anti-emetics such as Phenergan (promethazine), Zofran (ondansetron), Compazine (prochlorperazine), or over-the-counter meds such as Pepto-Bismol/Kaopectate (bismuth subsalicylate) or Benadryl (diphenhydramine).
- Feeding tube. If you are unable to tolerate any food or liquids, your doctor may choose to insert a feeding tube or jejunostomy tube. This feeding tube will bypass your stomach and go directly into your small intestine. Some people may require an intravenous (IV) feeding tube that provides parenteral nutrition directly into a vein in the chest.
- Gastric electrical stimulation (GES). This involves using a small device implanted into your lower stomach. It sends electrical stimulation to trigger stomach muscle contractions which helps move your food more efficiently and can help reduce nausea and vomiting.
- Botulinum toxin (Botox). Your doctor may inject this into your pylorus sphincter, which is a ring of smooth muscle that connects the stomach and small intestine. It opens and closes to control the passage of food out of the stomach. Botulinum toxin relaxes the pyloric muscle and widens the opening, allowing food to pass more easily through.
- Pyloroplasty. This procedure permanently opens the valve at the bottom of the stomach, allowing contents to pass more easily into the small intestine.
What is the best medication for gastroparesis?
The best medication for the treatment of gastroparesis will depend on the individual’s medical condition, medical history, medications that the individual is already taking that may potentially interact with gastroparesis medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter FDA-approved gastroparesis medications.
Best medications for gastroparesis
Best medications for gastroparesis
|Drug name||Drug class||Administration route||Standard dosage||Common side effects
|Reglan (metoclopramide)||Prokinetic||Oral||10mg every 6 hours 30 minutes before meals and at bedtime.||Extrapyramidal symptoms, fatigue, restlessness, headache, drowsiness
|Zelnorm (tegaserod)||Prokinetic||Oral||6mg twice daily 30 minutes before a meal.||Headache, abdominal pain, nausea, diarrhea, gas
|Phenergan (promethazine)||Antiemetic /antihistamine||Oral||12.5mg to 25mg every 4 to 6 hours as needed.||Drowsiness, blurred vision, dry mouth, confusion
|Compazine (prochlorperazine)||Phenothiazine||Oral||5mg to 10mg every 6 to 8 hours as needed.||Insomnia, restlessness, anxiety, headache
|Trilafon (perphenazine)||Phenothiazine||Oral||Up to a maximum of 24mg daily divided into 2 or 3 doses.||Restlessness, agitation, confusion, sedation
|Antivert (meclizine)||Antiemetic/antihistamine||Oral||12.5mg to 25mg up to 4 times daily as needed.||Drowsiness, constipation, dry mouth, urinary retention
|Ery-Tab (erythromycin)||Macrolide antibiotic||Oral||250mg to 500mg three times daily before meals.||Abdominal pain, nausea, diarrhea, headache
|Zofran (ondansetron)||5-HT3 receptor antagonist||Oral||4mg to 8mg three times daily.||Headache, fatigue, constipation, dizziness
|Sancuso (granisetron)||5-HT3 receptor antagonist||Transdermal patch||3.1mg/24hr patch changed every 7 days.||Headache, diarrhea, constipation, drowsiness
|Motilium (domperidone)||Dopamine-2 antagonist||Oral||10mg tablet 15 to 30 minutes before meals and at bedtime as needed.||Dry mouth, headache, dizziness, lightheadedness
Your healthcare provider will determine the dosage which is right for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist and this is not a complete list.
What are the most common side effects of gastroparesis medications?
As with all medicines, those used for gastroparesis treatment will have some side effects depending on the class you are taking. Some of the most common side effects you might experience include:
- Dry mouth
- Abdominal pain
There are also some more serious side effects associated with medicines used to treat gastroparesis. With long-term use, almost all of these meds can cause serious and potentially fatal heart problems, including arrhythmias.
Metoclopramide also carries the risk of developing a condition known as tardive dyskinesia (TD), a neurological disorder that involves involuntary, rapid movements of the face and body.
Are there any home remedies for gastroparesis?
While medications are important in the treatment of gastroparesis, lifestyle and dietary changes can also prevent or relieve symptoms. Some of these include:
- Eat small, low-fat meals
- Eat more liquid foods such as soups or pureed foods
- Chew solid food thoroughly before swallowing
- Drink plenty of water
- Avoid high-fiber foods
- Quit smoking
- Avoid alcohol and carbonated drinks
- Don’t lie down for 2 hours after eating
- Walking after meals
- Chew gum after meals
Frequently asked questions about gastroparesis
Can gastroparesis be cured?
Although it can be a chronic, long-term condition, gastroparesis can be successfully managed with medications, lifestyle changes, and sometimes surgery. For those cases with an underlying cause such as surgery, diabetes, or medications, treating the cause can improve or resolve your symptoms.
Who is more likely to get gastroparesis?
The most common risk factors include diabetes, surgery on your esophagus, stomach, or small intestine, certain medications, some illnesses, and certain cancer treatments, such as radiation therapy on your chest or stomach area.
Can you die from gastroparesis?
Yes. If it gets severe enough you can get very malnourished and without proper treatment options and proper nutrition, you can die from complications due to gastroparesis.
What foods should you avoid if you have gastroparesis?
Certain food can worsen your symptoms and you should try and avoid these. Foods and drinks to avoid include fatty, high-fiber foods, raw fruits and vegetables, whole grain cereals, nuts, seeds, alcohol, and carbonated drinks.
Related resources for gastroparesis
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.