Prokinetic agent

Monotherapy with a PPI is not only more effective in patients not responding to an H2RA or prokinetic agent alone, but it also improves compliance with once-daily dosing and is ultimately more cost-effective. 

The combination of a prokinetic agent and acid-suppressing drug is used commonly in pediatric patients with GERD.27 Monotherapy with an H2RA is also used frequently ranitidine 2 to 4 mg/kg/day is effective in neonates and pediatric patients. 

Profuse or prolonged vomiting can lead to complications of dehydration and metabolic abnormalities. Patients must have adequate hydration and electrolyte replacement orally (if tolerated) or intravenously to prevent and correct these problems. Some pharmacologic treatments work locally in the GI tract (e.g., antacids and prokinetic agents), whereas others work in the central nervous system (e.g., antihistamines and antiemetics).1... 

Most pharmacokinetic interactions in transplantation occur due to interactions with the CYP enzyme system however, several interactions have been shown to occur via alternative mechanisms. One of the most notable is that seen between tacrolimus and some of the prokinetic agents. Cisapride and metoclopramide have been shown to increase the absorption of tacrolimus by enhancing gastric emptying.41... 

In some patients SIBO is caused by intestinal stasis secondary to motility defects, and the restoration of normal intestinal motility may represent an effective approach. Prokinetic agents have been shown to improve intestinal motility [ 15,16], and the use of this therapeutic approach has been shown to be effective in patients with scleroderma, low-dose octreotide proved to be useful in the reduction of bacterial overgrowth [17]. Unfortunately, cisapride was recently removed from the market due to car-diotoxicity, and, apart from an erythromycin analog without antibiotic effects which showed no effects in rats [18],... 

Greater skill is required to place the feeding tube beyond the pylorus. Prokinetic agents, such as metoclopramide or erythromycin, facilitate... 

Mohammad, A.H., Jabed, C.W. and Jones, R.W. (1997). Blockage of the HERG human cardiac K channel by gastrointestinal prokinetic agent cisapride. Am. J. Physiol. 273, H2534-H2538. 

II.b.2.1. Prokinetic agents. Cisapride cisapride treatment can be demonstrated to improve sphincter and motor function and to improve modestly the symptoms of heartburn. However, it is relatively ineffective in severe disease, and adverse effects of impaired intracardiac electrical conduction causing ventricular tachyarrhythmias have resulted in its withdrawal from general use. 

Prokinetic agents, metoclopramide and domperi-done, have been shown to relieve dysfunctional upper gastrointestinal symptoms, and are presumed to act through improving co-ordination of gastric emptying. 

It is a novel prokinetic agent, it inhibits dopamine receptors at the parasympa-... 

Metoclopramide is available for clinical use in the USA domperidone is available in many other countries. These agents are sometimes used in the treatment of symptomatic GERD but are not effective in patients with erosive esophagitis. Because of the superior efficacy and safety of antisecretory agents in the treatment of heartburn, prokinetic agents are used mainly in combination with antisecretory agents in patients with regurgitation or refractory heartburn. 

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