Prokinetic drugs

Approaches to treatment. The step-up approach involves starting with lifestyle modification (above) and an antacid, progressing as necessary to a receptor antagonist and prokinetic drug, and a proton pump inhibitor only in those who fail to respond to less powerful measures. The converse ( step down ) approach advocates rapid control of symptoms with a proton pump inhibitor followed by substitution with less potent treatments, which are titrated against symptoms. Evidence suggests that this latter approach may be more cost-effective. 

Troleandomycin may inhibit the metabolism of ecabapide, a gastric prokinetic drug, by inhibiting CYP3A4 (9). 

Similar to other prokinetic drugs, erythromycin has been shown to improve gastric emptying in humans and laboratory animals. In horses, erythromycin lactobionate, at both 0.1 and l.Omg/kg, reduced the T50 of solid-phase gastric emptying (Ringger et al 1996). 

These external neural influences on intestinal motility are common targets for prokinetic drugs, but events within the bowel can have important effects on intestinal motility and cause the bowel to be refractory to traditional prokinetic therapy. Release of cytokines from activated inflammatory cells is probably an important feature of ileus in many cases. Ileus secondary to reperfusion injury is an anticipated response in horses with small intestinal obstruction. However, even apparently mild intestinal injury can initiate cellular responses that lead to impaired motility. Mild intestinal insult by gentle surgical manipulation activated adhesion molecules on leukocytes and increased the expression of P-selectin and intercellular adhesion molecule 1 on endothelial cells within the vasculature of the muscularis layer of the intestine (Kalff et al 1999). Surgical manipulation of the rodent small intestine resulted in substantial extravasation of leukocytes into the intestinal muscularis, consisting mainly of polymorphonuclear neutrophils, monocytes and mast cells and lasting for days. This cellular inflammatory response within the intestinal muscularis externa was associated with a marked decrease in jejunal circular muscle activity (Kalff et al 1998). 

Cardiovascular Gastroesophageal reflux occurs frequently during the first months of life and, owing to immaturity of the esophagus and stomach, can frequently lead to serious complications, particularly in preterm infants, in whom prokinetic drugs are often used to prevent the symptoms and complications. The withdrawal of cisapride from drug market has resulted in overuse of domperidone, which can also cause cardiac dysrhythmias by prolongation... 

Drugs (narcotic analgesics, anticholinergics, prokinetic drugs, antidepressants etc) ... 

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