Prokinetics

The most widely studied prokinetic in the treatment of nonulcer dyspepsia is cisapride, but it is currently available in the United States only through an onerous limited access protocol. Although cisapride appeared significantly better than placebo in reducing dyspeptic symptoms, many of the available trials were small in size and publication bias may have influenced results. Comparisons of cisapride with metoclo-pramide or domperidone or metoclopramide with dom-peridone have not demonstrated the superiority of one agent over another (Fumagalli and Hammer, 1994; Halter et al, 1997; Van Outryve et al, 1993). Motilin agonists have not been well studied, but a recent trial with ABT-229 found it to actually be inferior to placebo in providing symptom relief. Domperidone can be obtained from non-US-based pharmacies, often without a prescription. It may also be obtained from compounding pharmacies in the United States with a prescription, but it tends to be much more expensive. Because domperidone has both antiemetic and prokinetic effects without central nervous system toxicity, it is often helpful in patients with dysmotility-like dyspepsia. The starting dose is 10 mg before meals and at bedtime. Although metoclopramide (Reglan) remains our first line prokinetic because of availability and expense, domperidone is used in patients who either do not respond to or do not tolerate metoclopramide. To date, there are no published trials of the partial 5-HT4 agonist tegaserod in the treatment of nonulcer dyspepsia, but this agent may have efficacy in a subset of patients.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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