Pharmacology & Anesthesia: Prokinetics

Prokinetics

Metoclopramide (Reglan)

  • Mechanism: Dopamine Receptor Antagonist
  • Indications:
    • Gastroparesis
    • Nausea & Vomiting
    • Refractory GERD

Erythromycin

  • Mechanism: Activates Motilin Receptors on Smooth Muscle
    • Primarily Used as an Antibiotic
  • Use as a Prokinetic is Considered Off-Label

Alvimopan (Entereg)

  • Mechanism: Peripheral Opioid Receptor Antagonist in the GI Tract
    • Limited Systemic Absorption & Limited Crossing of the Blood-Brain Barrier, Allowing Continued Opioid-Mediated Pain Control
  • Indication: Prevention of Postoperative Ileus After Colorectal Surgery
  • Dosing: Oral 12 mg BID
    • Start: POD#1
      • Give Initial Dose: 30 Minutes-5 Hours Preop
    • Stop: Discharge; Maximum 7 Days (15-Doses)
  • Side Effects: MI
  • Effectiveness:
    • Decreased Time to Return of Bowel Function (5-28 Hours)
    • Decreased Hospital Length of Stay (24 Hours)