Pro-kinetic agents

Patients with liver disease may have an increased gastrointestinal transit time [3]. These patients may benefit from taking a pro-kinetic agent, as normalisation of gastrointestinal motility will reduce the time available for the absorption of nitrogenous compounds that may precipitate encephalopathy. The use of pro-kinetic agents has also been shown to reduce intestinal bacterial overgrowth in patients with cirrhosis [4-6]. 

Domperidone may be the antiemetic of choice, but as the patient has very little metabolic and synthetic liver function, owing to massive hepatocellular necrosis secondary to the hepatotoxic effects of the paracetamol overdose, accumulation of the domperidone may occur. However, it may be of benefit as a pro-kinetic agent. 

Peeters TL. Erythromycin and other macrolides as pro-kinetic agents. Gastroenterology 1993 105(6) 1886-99. 

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