Reglan Use for Heartburn

Also known as pyrosis, the "burning" sensation is actually caused by excess amounts of stomach acid that is regurgitated into the esophagus. The pain is most evident just below the breastbone and can mimic some of the symptoms of heart problems.

Heartburn is one symptom of a more serious condition known as Gastroesophageal Reflux Disease, or GERD, sometimes referred to as "acid reflux." There are several treatments and remedies for this condition, not all of which are effective and only a few that treat the underlying symptoms. One such treatment has been the prescription drug metoclopramide, sold by Schwarz Pharma and others as a pill and Baxter International as an injection under the trade name Reglan.

Although not normally indicated for psychosis, Reglan is similar to such antipsychotic/neuroleptic medications in that it is a dopamine receptor antagonist, acting to block signals from the brain to certain parts of the body. It treats the symptoms of heartburn by preventing these signals from relaxing the muscles of the upper gastrointestinal tract.

Effectiveness and Limitations of Reglan

Reglan has been found to be an effective short-term remedy for the majority of patients for whom it is prescribed, particularly in combination with H2 blockers (medications that decrease the production of stomach acid). However, it does not address physical damage already suffered in the esophagus. Approximately 20 percent of patients are unable to deal with the immediate side-effects of the drug, which primarily consist of fatigue or restlessness.

Other immediate side effects may include involuntary movements of the extremities within the first day or two of treatment, particularly in children and young adults. Long-term side effects include depression and involuntary movement disorders associated with tardive dyskinesia and Parkinson's disease. Older women are especially susceptible.

Generally, patients suffering from any of the following conditions should avoid taking Reglan:

Ulcer and/or gastrointestinal bleeding
Asthma
Hypertension
Clinical Depression
Parkinson's Disease
Epilepsy
Kidney Disease

In addition, pregnant and/or nursing women should avoid taking Reglan, as the drug can be passed to the child through breastfeeding.

Reglan Alternatives

"Proton pump inhibitors" such as Prilosec, Prevacid or Nexium have been shown to be effective in preventing symptoms associated with heartburn by reducing the production of hydrochloric acid in the stomach. However, these are not suitable for long-term use, as inhibiting the production of stomach acid can prevent the destruction of certain harmful pathogens normally killed in the stomach.

Additionally, some research now suggests that older patients who take proton pump inhibitors may be more likely to suffer hip fractures. It should also be noted that over-the-counter antacids merely relieve symptoms without addressing the underlying cause. These can also cause a "back-lash" effect and aggravate the problem.

Sources

Associated Press. "Heartburn Drugs Tied to Hip-Fracture Risk." MSNBC News, http://www.msnbc.msn.com/id/16358462/, 29 December 2006.
Karlet, Mary and Linda Scheetz. Nurse Anesthesia Secrets. (Elsevier Health Sciences 2005).
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)