Gastroparesis: pharmacotherapy and cardiac risk

Abstract

Background: Gastroparesis is characterized by abnormal gastric motility and delayed emptying with symptoms of early satiety, postprandial fullness, bloating, nausea, vomiting and abdominal pain. Pharmacological discovery has been lagging because potential drugs often are associated with abnormalities of electrical conduction of the myocardium due to interaction with cardiac ion channels leading to limited pharmaceutical options for development of new drugs.

Objective: Addresses the safety of drugs for gastroparesis in terms of cardiotoxicity related to the clinical use of prokinetics and antiemetics.

Methods: Survey of QT drugs List and review of current literature.

Results: Many prokinetic drugs are associated with cardiac adverse events and manifest as prolongation of ventricular repolarization, i.e., QT-interval prolongation of the electrocardiogram. This disturbance may develop into a potentially fatal polymorphic ventricular tachyarrhythmia; Torsade de Pointes. Co-administration of prokinetics with other drugs affecting the repolarization process, pharmacokinetic interactions leading to increased blood levels, or the presence of clinical risk factors could further increase the risk for cardiac arrhythmias.

Conclusions: It is important that clinicians managing gastroparesis are aware of the arrhythmogenic potential of drugs used clinically and risk factors that contribute to QT prolongation to safeguard patients at risk for drug-induced cardiac arrhythmia.

Keywords:

• Torsade de pointes
• QT interval prolongation
• gastroparesis
• gastroprokinetic
• prokinetic
• adverse drug reactions

Disclosure statement

Assoc. prof. Ahmad Al-Saffar was previously Associate Director and Principle Scientist at Department of Safety Pharmacology, AstraZeneca R&D, Södertälje, Sweden. Language revision carried out by assoc. prof. Dominic-Luc Webb, Uppsala University. No other disclosures.

Additional information

Funding

Uppsala University.