Reglan

Reglan & Diabetic Gastroparesis

Gastroparesis is a condition that results from damage to the vagus nerve, which controls contractions of the stomach. 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 the brand name Reglan.

Function and Limitations of Reglan

Reglan is a dopamine antagonist/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. If the transmission of these signals to the stomach are blocked, contractions that force digested food into the upper intestines may begin.

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. Some of the side effects of Reglan begin at this time and may become permanent. Approximately 20 percent of those who are prescribed Reglan experience symptoms of either fatigue or extreme physical restlessness within a few days.

Children and young adults may experience uncontrollable movements of the extremities. Additional symptoms that begin to appear after 90 days include clinical depression, parkinsonism and tardive dyskinesia. Older women over the age of 55 are generally at a higher risk for developing these symptoms, which are usually irreversible.

Who Should Avoid Reglan

Those experiencing the following conditions should not take Reglan:

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

Reglan is not recommended for women who are pregnant or nursing. Studies have 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. 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.

Sources

  1. Associated Press. "Heartburn Drugs Tied to Hip-Fracture Risk." MSNBC News, http://www.msnbc.msn.com/id/16358462/ , 29 December 2006.
  2. DeVault, K.R. and D.O. Castell. "Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease." American Journal of Gastroenterology, vol.94 no. 6 (1999),
  3. Karlet, Mary and Linda Scheetz. Nurse Anesthesia Secrets. (Elsevier Health Sciences 2005).
  4. Life Clinic. "Complications of Diabetes: Gastroparesis." http://www.lifeclinic.com/focus/diabetes/gastro.asp
  5. Shaffer, Douglas et. al. "Tardive Dyskinesia and Metoclopramide Use: Effects of Cisapride Market Withdrawal." Journal of the American Pharmacists Association vol. 44 no. 6 (2004).