Metoclopramide stimulates upper GI motility and has antiemetic properties. It doesn't stimulate gastric, pancreatic, or biliary secretions. It enhances gastric contractions, relaxes the pyloric sphincter (where the stomach empties into the upper intestine), and increased upper intestinal peristalsis (movement and digestion). It lowers some esophogeal tone, which reduces gastric reflux. There is little to no effect on colon motility (the end of the intestinal tract).
Metoclopramide's drug interactions are known with atropine (an anticholinergic), anticholinergics in general, and narcotic analgesics (pain killers like butorphanol, oxymorphone, etc.)
It may increase the drug effects of narcotics, other sedatives, cimetidine (Tagamet), tetracycline, aspirin, acetaminophen (Tylenol), and diazepam (Valium). Drugs that dissolve in the stomach may have less absorption (like digoxin, a cardiac med that is not much in use any more).
Dosing is usually 0.2-1 mg/kg PO, SQ, IM q12h.
It is light sensitive, so it should be stored in dark containers and places.
Cisapride increases the lower esophogeal peristalsis, esophogeal sphincter pressure, and accelerates gastric emptying.
It is contraindicated in pregnancy and may be light sensitive, depending upon manufacturer. Use in small animal medicine has not been common, especially since it was taken off of the human market for causing heart dysrhythmias. Thus, not all adverse effects are known and more develops as time progresses. It also decreases gastric transit time and can lower absorption of some drugs given orally. It is also contraindicated with anticholinergic drugs. Absorption and effects of cimetidine, anticoagulants, alcohol, and some sedatives may be increased. Ketoconazole, itraconazole, IV miconazole, or troleandomycin are all contraindicated.
The dosing on cisapride is usually 0.1-0.5 mg/kg PO q12h.
Metoclopramide (Reglan) & Cisapride (Propulsid)
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