Current and emerging pharmacotherapy for the treatment of gastroparesis

ABSTRACT

Introduction

Gastroparesis is a chronic disorder characterized by decreased gastric emptying and presents with nausea, vomiting, and abdominal pain which impacts patients’ quality of life greatly. The treatment modalities available for gastroparesis have been expanding over the past 2 decades. Currently, there are multiple options available for gastroparesis, albeit with only one FDA-approved medication until June 2021.

Areas covered

We review the different treatments available for gastroparesis and discuss the recently FDA-approved intranasal formulation of metoclopramide. This nasal spray guarantees metoclopramide absorption within 15 min of application bypassing first pass metabolism in the liver and overcoming the limitations of the oral formulation not passing into the small intestine for absorption because of a gastroparetic stomach or a patient unable to take the oral metoclopramide because of nausea and vomiting.

Expert opinion

We now find ourselves in an oasis after spending many years in a ‘desert’ regarding pharmacologic therapies available for gastroparesis. The expansion of the research involving dopamine receptor antagonists and delving into alternative mechanisms of alleviating gastroparesis symptoms has been crucial in the landscape of gastroparesis. This is especially true as our knowledge of gastroparesis has proven that simply improving gastric emptying does not necessarily translate to clinical improvement.

KEYWORDS:

• Gastroparesis
• metoclopramide
• dopamine receptor antagonists
• 5HT4 agonists
• novel pharmacotherapy

Article highlights

• Gastroparesis is a chronic disease entity associated with decreased quality of life and increased economic burden on the patient and the healthcare system.

• Treatment modalities for gastroparesis have been largely based on the use of off-label medications.

• The risk of tardive dyskinesia secondary to oral metoclopramide is approximately 0.1% which is much lower than previous estimates, and quantification of this risk is crucial as patients will often require treatment longer than 12 weeks consecutively.

• The FDA approved a nasal formulation of metoclopramide in June 2021 with the advantage of better tolerability in patients with active nausea and vomiting and improved absorption.

• Despite the recent approval of intranasal metoclopramide, further research is needed on peripheral dopamine receptor antagonists and the 5HT4 agonist medication class to increase the options available to patients with this debilitating disease.

Declaration of interest

M A Kalas and R W McCallum are consultants for Evoke Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.