Prokinetic drugs: what they do and when you might need them

Prokinetic drugs speed up how food and liquids move through the stomach and intestines. People usually use them for gastroparesis (slow stomach emptying), persistent nausea, reflux that doesn’t respond to acid meds, and some forms of chronic constipation. They can make eating easier, reduce bloating, and help with nausea that won’t go away on its own.

Common prokinetics and how they differ

Metoclopramide (Reglan) boosts stomach contractions and helps with nausea. It works fast but shouldn’t be used long-term without a doctor’s supervision because of movement-related side effects.

Domperidone (often sold as Motilium) helps nausea and improves gastric emptying with less risk of brain-related movement problems, but it can affect the heart in some people. Some countries limit its use or require ECG checks first.

Prucalopride is a newer option mainly for chronic constipation; it increases bowel movement frequency by stimulating colonic motility and is usually used when laxatives fail.

Erythromycin, an antibiotic, has a secondary prokinetic effect by acting on motilin receptors. Doctors sometimes use low-dose, short courses for gastroparesis, but long-term use can cause tolerance and antibiotic resistance.

Cisapride was effective but withdrawn or restricted in many places because of serious heart rhythm problems. It’s an example of why monitoring and safety matter with this drug class.

Side effects, interactions, and real-world tips

Side effects vary by drug. Metoclopramide can cause drowsiness, restlessness, and with longer use, tardive dyskinesia — a potentially permanent movement disorder. Domperidone may prolong the QT interval and raise the risk of arrhythmia in people with other heart risks or on interacting drugs. Prucalopride’s common complaints are headache and nausea when starting treatment.

Watch for drug interactions: some antibiotics, antidepressants, and antifungals raise heart-risk when combined with domperidone. Erythromycin taken with other QT-prolonging meds multiplies risk. Always tell your provider about all medicines, supplements, and heart history.

Practical tips: get a clear diagnosis before starting a prokinetic. Ask your doctor how long you should use it — many prokinetics are for short courses or specific conditions. If you have heart disease, fainting, irregular heartbeat, or take other QT-risk drugs, request an ECG before starting domperidone. Report any new involuntary movements, tremors, or severe restlessness right away.

If you’re buying meds online, use a licensed pharmacy and keep your prescription. Talk with the pharmacist about interactions and warnings. When used carefully and under supervision, prokinetic drugs can be very helpful, but they need respect for safety and monitoring.