prokinetic FAQ

As soon as you start eating, your body begins the process of digesting your food. It does this through peristalsis. Peristalsis is a series of wave-like contractions that moves your food from your esophagus to your stomach and small intestines. These contractions help your body absorb nutrients from your food. Peristalsis is also an important part of moving your food to your rectum where it can be excreted as waste. You have nerves and muscles that are involved in peristalsis. Disorders that interfere with how these nerves and muscles work can cause issues with this function. Sometimes the problem can be in your lower esophageal sphincter (LES), a bundle of muscles at the bottom of your esophagus. When your LES is closed, it prevents the contents of your stomach from going back up into your esophagus. If your LES isn't working properly, you may experience acid reflux or heartburn. Prokinetic agents strengthen the contractions of your LES muscles and help stimulate the other muscle contractions in the entire GI tract.

There are several types of prokinetic agents, including: Cholinergic agonists. These medications act on the neurotransmitter acetylcholine, which is part of your parasympathetic nervous system (PNS). Neurotransmitters carry messages throughout nerve cells. One of the functions of the PNS is controlling your digestion. The prokinetic agents in this class include bethanechol, which was used to treat heartburn and gastroparesis, a condition that causes partial paralysis in your stomach. Bethanechol is not often used for this anymore because of its side effects. Neostigmine and pyridostigmine are two other cholinergic agonists that are still used for certain conditions that slow down peristalsis, such as Ogilvie's syndrome and pseudo-obstruction. Dopamine antagonists. Metoclopramide and domperidone are two types of prokinetic dopamine antagonists. These work by binding with and blocking dopamine receptors, which are a type of neurotransmitter. Metoclopramide, which was sold under the brand name Reglan, is used to treat gastroparesis and heartburn. Domperidone is not approved for use in the US without special permission from the FDA. There are serious risks associated with domperidone, including abnormal heart rhythms, heart attack, and even sudden death. Serotonergic agonists. Serotonergic agonists work by activating serotonin receptors, which is another type of neurotransmitter. Cisapride, prucalopride, and tegaserod are examples of medicines that work this way. Unfortunately, cisapride and tegaserod were associated with serious cardiac risks. They were pulled from the market because of this. ‌ Prucalopride is used to treat constipation that doesn't respond to other treatments. It has not shown the cardiac side effects that happened with cisapride and tegaserod. Macrolides. These are antibiotics that also act as prokinetic agents. Azithromycin and erythromycin have been shown to help with gastroparesis. However, there are problems associated with long-term antibiotic use. Because of problems with antibiotic resistance, using macrolides as a prokinetic agent should be avoided.

Generic and brand names of prokinetic agents include:

Prokinetic agents are administered intravenously or taken orally and are used to treat:

Prokinetic agents refer to a class of drugs that promote the passage of ingested material in the gastrointestinal tract. They are mainly beneficial for treating motion problems caused by various medical conditions and gastroesophageal reflux disorders. Prokinetic agents act in the following ways:

Prokinetic agents can cause some side effects, including: