Reglan & Diabetic Gastroparesis

Gastroparesis, literally "stomach paralysis," is a condition that results from damage to the vagus nerve, which controls contractions of the stomach that force digested food into the intestinal tract. In diabetics, the vagus nerve may be damaged by years of poorly-controlled glucose levels. As a result, food moves very slowly through the digestive tract, or may stop moving altogether. This condition is called autonomic or visceral neuropathy, a disorder of the non-sensory, or autonomic nervous system that controls involuntary muscle function.

One of the primary treatments for diabetic gastroparesis is the drug metoclopramide, better known by its market brand, Reglan.

Function

Reglan is a dopamine antagonist, or inhibitor. Dopamine is produced in the brain and acts as a neurotransmitter that carries signals from the brain to receptors on cells throughout the body. Blocking the transmission of these signals to the stomach causes contractions that force digested food into the upper intestines, thus emptying the stomach.

Limitations of Reglan

Although the use Reglan has been shown effective in stimulating stomach contractions needed to move digested food out of the stomach chamber, it should not be used for longer than 90 days without a thorough medical evaluation. The reason is that certain side effects, some of which can be permanent, begin to manifest after this time. 20 percent of those who are prescribed Reglan experience symptoms of either fatigue or extreme physical restlessness within a few days. Children, adolescents and young adults may also experience uncontrollable movement of the extremities.

Additional symptoms that begin to appear after 90 days include clinical depression, parkinsonism and tardive dyskinesia. Older women and others over the age of 55 are at highest risk for developing these symptoms, which are generally irreversible.

Do not Take Reglan If...

The following medications are known contraindications for Reglan:

Asthma
Clinical Depression
Kidney Disease
Hypertension
Parkinson's Disease
Ulcerative Bleeding

Reglan is also not recommended for women who are pregnant or nursing. Studies has also indicated that older patients (over age 55) suffer an increased risk of hip fracture after taking Reglan for an extended period.

Reglan Alternatives for Gastroparesis

Fortunately, Reglan is not the only available treatment for diabetic gastroparesis. Erythromycin, a general antibiotic similar to penicillin, has been found effective in the treatment of this condition. This is not usually the first line of treatment because of the many side effects, which can include diarrhea, nausea, chest and stomach pain, jaundice and vomiting; in rare cases, irregular heartbeat (arrhythmia) can occur. Drugs known as antiemetics, which block serotonin receptors in the gastrointestinal tract and are used to treat motion sickness can help in dealing with nausea.

Patients can also try eating several small meals per day rather than three larger ones, switch to liquid nourishment until symptoms of gastroparesis are gone, and avoid high-fat and high-fiber foods.

Free information packet on Tardive Dyskinesia

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