Erythromycin is a useful adjunctive therapy that can be added to metoclopramide or domperidone if nausea and vomiting persist despite maximal tolerated doses of these agents. It attaches to the motilin receptor and stimulates enteric contractility. It is not an antiemetic and concomitant agents to address nausea must also be initiated with this agent. Both intravenous and oral forms have been shown to improve gastric emptying rates, but this therapy can be complicated by cramping and abdominal pain. Low doses in a liquid (syrup) form are best to treat gas-troparesis (eg, 125 mg 2 or 3 times daily). A potential concern with this agent is that it loses effectiveness over time due to down regulation of the motilin receptor.
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