Reglan & Gastroesophageal Reflux Disease (GERD)
Also known as acid reflux disease, gastroesophageal reflux disease, or 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.
Two things are happening in these patients, both related to faulty signaling from the brain. First, the valve, or sphincter at the top of the stomach fails to close properly; secondly, the stomach muscles are failing to move digested food into the intestinal tract.
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.
How It Works
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.
Reglan is not a treatment for the injury to the mucous linings of the esophagus and pharynx. There are also immediate side effects that appear in approximately 20 percent of patients; these include chronic fatigue or may manifest itself as agitation or a compulsive need to move.
These involuntary movements may affect children and young adults (under age 30) in particular.
Patients who take Reglan longer than three months may experience clinical depression, parkinsonism and tardive dyskinesia; 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; raise blood pressure; and affect 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 is known to be in breast milk; in any case, Reglan 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:
- Prilosec
- Prevacid
- Nexium
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 risk infection. In addition, studies indicate that elderly patients who take proton pump inhibitors may run an increased risk of hip fracture.
About Over-The-Counter Medications
OTC medications can be effective in relieving symptoms by neutralizing stomach acid. However, products such as TUMS, Rolaids or Alka-Seltzer do not treat the underlying causes, and may in fact cause an increase in symptoms once the effects wear off. It should also be noted that bicarbonate of soda, a popular home remedy, is a form of sodium and is unsuitable for patients suffering from hypertension.
© 2010 TardiveDyskinesia.com Last Modified Monday, July 27th, 2009
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