of the Week:
Metoclopramide is the preferred prokinetic agent in the critical care population.
There are three major prokinetic agents available. Metoclopramide and domperidone are dopaminergic agents which have an effect mainly on the esophagus and stomach, with minor effects on the small intestine. Cisapride is a cholinergic-like agent that also has activity on the esophagus and stomach, but has additional effects on the colon and anal sphincter.
There are a variey of reasons why metoclopramide remains the number one choice:
- fewer drug interactions, specifically with erythromycin, clarithromycin, fluconazole or fluoxetine
- better side effect profile (no cardiac effects)
- can be used in patients with history of cardiac disease, arrhythmias or renal failure
- metoclopramide is available in both an enteral and intravenous preparation
- metoclopramide has less effect on the large intestine thus tends to cause less diarrhea
- less expensive product
Product Monograph, 1999
Cisapride Product Monograph, 1999
Drug Information, American Hospital Formulary Service, 1999
February 11, 2000