9 Medications To Avoid With Gastroparesis.

Quick Insights.

Several medications can delay gastric emptying and should be avoided with gastroparesis. However, most of the below-listed medications are vital to treat or prevent serious diseases. Don’t stop or change your medications without consulting your health care provider.

Common medications to avoid with gastroparesis include:

• Calcium Channel Blockers: used for hypertension and heart diseases.
• Tricyclic Antidepressants.
• Narcotic pain relievers.
• Dopamine agonists: used mainly for Parkinson’s disease.
• Alpha-2-adrenergic agonists: used for hypertension, opioid withdrawal symptoms, and ADHD.
• Muscarinic cholinergic receptor antagonists: used widely in irritable bowel syndrome (IBS).
• Phenothiazines: used in psychiatric diseases like schizophrenia.
• Glucagon-like peptide-1 agonists: used in the treatment of diabetes mellitus.
• Cyclosporine: an immunosuppressant medication used for autoimmune disease s and to prevent organ transplant rejection.

1- Calcium Channel Blockers (Anti-Hypertension and for heart diseases).

Calcium channel blockers are one of the most commonly prescribed medications.

Common uses of calcium channel Blockers:

1- Anti-hypertensive (blood pressure-lowering).

2- Anti-arrhythmic (regulate your heartbeats).

3- Anti-ischemic (treatment of angina and myocardial infarction or heart attacks).

4- Anti-failure (treatment of heart failure).

Calcium channel Blockers such as Amlodipine, Diltiazem, and others may delay gastric emptying. The use of these agents may worsen the symptoms of gastroparesis. Consult your doctor about the possible use of alternatives that don’t impact your gastroparesis.

Common examples of calcium channel blockers (CCBs) that may delay gastric emptying.

• Amlodipine (Norvasc).
• Diltiazem (Cardizem, Tiazac).
• Nifedipine (Adalat CC, Procardia).
• Verapamil (Calan, Verelan).
• Felodipine.
• Isradipine.
• Nicardipine.

2- Tricyclic antidepressants.

Full dose Tricyclic antidepressants (TCAs) causes a delay in gastric emptying. So, these medications (at full dose) should be avoided with gastroparesis. TCAs are used to treat psychiatric diseases such as depression and anxiety.

Common TCAs:

• Amitryptiline (Elavil).
• Nortriptyline  (Aventyl, Pamelor).

However, a low dose of the tricyclic antidepressant (amitryptiline) is used to treat gastroparesis. This is because the low dose doesn’t result in delayed gastric emptying. It improves nausea and abdominal pain.

3- Narcotic pain relievers.

Examples:

• Oxycodone (OxyContin, Roxicodone, and Percocet)
• Hydrocodone (Vicodin, Norco, Lortab)
• Morphine (MS Contin and Kadian)
• Hydromorphone (Dilaudid and Exalgo)
• Fentanyl (Actiq, Fentora, Duragesic, Subsys, Abstral, and Lazanda).

Narcotic pain relievers are used mainly to control severe pain. pain in the post-operative periods and chronic cancer pain are the commonest causes. Narcotic pain relievers significantly delay gastric emptying. (ref)

4- Dopamine antagonists.

Dopamine agonists are medications that mimic the actions of dopamine. They are used in diseases attributed to low dopamine levels. They are most commonly used in Parkinson’s disease and restless leg syndrome.

Dopamine agonists such as Bromocriptine and Cabergoline can delay gastric motility. They may worsen the symptoms of gastroparesis. Ask your doctor about alternatives. (ref)

Common Dopamine agonists:

• Bromocriptine (Parlodel)
• Cabergoline (Dostinex)
• Apomorphine (Apokyn).
• Pramipexole (Mirapex).
• Ropinirole (Requip).
• Pergolide (withdrawn from the USA market).

5- Alpha-2-adrenergic agonists.

Alpha2-agonists are used to treat hypertension, opiate withdrawal, and Attention Deficit Hyperactivity Disorder (ADHD). The use of alpha 2 agonists slows gastric emptying and can worsen gastroparesis symptoms. (ref).

Tizanidine (Zanaflex) is a common medication that is used as a muscle relaxer. The medications also can delay gastric emptying and worsen gastroparesis.

Commonly used alpha-2-agonists:

• Clonidine (Catapres)
• Methyldopa (Aldomet)
• Tizanidine (Zanaflex) – used as a muscle relaxer.
• Clonidine (Kapvay) – used to treat ADHD.
• Guanfacine (Intuniv) – used to treat ADHD.
• Lofexidine (Lucemyra) – FDA-approved to treat opiate withdrawal.

6- Muscarinic cholinergic receptor antagonists.

Common examples:

• Atropine (Atropine)
• Belladonna alkaloids.
• Benztropine mesylate (Cogentin)
• Clidinium (in Librax).
• Cyclopentolate (Cyclogyl)
• Darifenacin (Enablex)
• Dicyclomine (Bentyl).
• Fesoterodine (Toviaz)

Clinidium (In Librax) and Dicyclomine (Bentyl) are two commonly used medications for Irritable Bowel syndrome (IBS). they may increase bloating, constipation, and delayed gastric emptying. (ref)