Reglan & Gastroesophageal Reflux Disease (GERD)
Also known as acid reflux disease, gastroesophageal reflux disease (GERD) is actually a set of symptoms that is caused by a number of factors, primarily an abnormal reflux or backwash of hydrochloric acid from the stomach. This acid washes up into the esophagus and even as far as the throat (in which case it is identified as laryngopharyngeal), causing the painful burning sensation and even injury to the mucous membranes.
Metoclopramide, marketed by Schwarz Pharma and Baxter International under the brand name Reglan, has until recently been considered one of the leading treatments for patients suffering from GERD.
Like many anti-psychotic medications, Reglan is a dopamine inhibitor. Dopamine is the brain chemical that transmits signals from the brain to various bodily systems. By blocking these signals from the dopamine receptors on the surface of stomach cells, the muscles are prevented from relaxing. Thus, the esophageal sphincter is forced closed and contractions of the stomach are stimulated, forcing digested food into the intestines at a faster rate.
Effectiveness and Limitations
With short-term usage, Reglan has been demonstrated to be highly effective when used in combination with medications known as H2 blockers, which inhibit the production of stomach acids. There are also immediate side effects that appear in approximately 20 percent of patients, including chronic fatigue or a compulsive need to move.
These involuntary movements may affect children and young adults in particular. Patients who take Reglan longer than three months may experience clinical depression, symptoms of Parkinson's disease and tardive dyskinesia. Those most at risk are women and others over the age of 55.
Who Should Avoid Reglan
Patients who have ulcers or some form of gastrointestinal bleeding should not take Reglan. In addition, Reglan is known to aggravate symptoms associated with asthma, Parkinson's Disease and kidney disorders. It can also raise blood pressure and have an impact on patients diagnosed with clinical depression. While it has not been established that Reglan can pass from a pregnant woman to her fetus through the placental barrier, it can be transferred through breastfeeding so it is not recommended for pregnant and nursing women.
Other Options for Patients
There is a different class of drugs, known as proton pump inhibitors, that address the symptoms of GERD by reducing the production of stomach acid. Brand names include:
Since stomach acid is one of the body's first lines of defense against pathogens, it is recommended that such proton pump inhibitors be used on a short-term basis only. Patients who take such a drug for longer than three months may risk infection. In addition, studies indicate that elderly patients who take proton pump inhibitors may run an increased risk of hip fracture.
- Associated Press. "Heartburn Drugs Tied to Hip-Fracture Risk." MSNBC News, http://http://www.msnbc.msn.com/id/16358462/ , 29 December 2006.
- 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).
- 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).
- Wolfe, Michael and Thomas J. Nesi. Heartburn. (New York; W.W. Norton & Company, 1997).