Prokinetic agents for gastroesophageal reflux disease (GERD)

Examples

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Brand Name	Chemical Name
Reglan	metoclopramide hydrochloride

Prokinetic agents are taken by mouth (orally) in pill or liquid form (Reglan syrup).

How It Works

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Prokinetic agents:

• Make the valve between the esophagus and stomach (lower esophageal sphincter) squeeze shut more tightly. This makes it harder for stomach acid and juices to back up, or reflux, into the esophagus.
• Make the stomach empty quicker, which reduces the amount of acid in the stomach.

Why It Is Used

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Prokinetic agents are used to treat heartburn caused by gastroesophageal reflux disease (GERD). Prokinetic agents may be used along with H2 blockers (acid reducers) to help clear stomach juices from the esophagus and stomach.

How Well It Works

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Prokinetic agents can be effective when used with H2 blockers but are not the first choice for treating GERD symptoms because proton pump inhibitors usually work better and have fewer side effects.

Side Effects

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More than 30% of the people taking metoclopramide have side effects.¹ These include:

• Nausea.
• Diarrhea.
• Nervous system side effects, such as jumpiness, confusion, or sleeplessness. These occur in 20% to 40% of people who take the medication.²

Metoclopramide is known to have interactions with other medications. Talk to your doctor about taking metoclopramide if you are also taking other medications.

In some people, metoclopramide may cause depression. In older adults, it can cause shaking or trembling (parkinsonian-like symptoms) and involuntary movements of the facial muscles and tongue (tardive dyskinesia).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Prokinetic agents are not usually used to treat GERD. H2 blockers or proton pump inhibitors are more commonly used.

Some doctors may prefer to use a combination of a prokinetic drug and an H2 blocker to treat GERD symptoms before using a proton pump inhibitor. But this may cost more than using a proton pump inhibitor alone.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Spechler SJ (2003). Gastroesophageal reflux disease and its complications. In SL Friedman et al., eds., Current Diagnosis and Treatment in Gastroenterology, 2nd ed., pp. 266–282. New York: McGraw-Hill.

2. Fisher RS (2000). Treatment of gastroesophageal reflux disease. In MM Wolfe et al., eds., Therapy of Digestive Disorders, pp. 3–16. Philadelphia: W.B. Saunders.

Credits

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Author	Merrill Hayden
Editor	Kathleen M. Ariss, MS
Editor	Katy E. Magee, MA
Associate Editor	Michele Cronen
Associate Editor	Pat Truman
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Peter J. Kahrilas, MD - Gastroenterology
Last Updated	April 18, 2006