Prokinetic Agents

The agents capable of promoting appropriate GI motility, particularly in GERD are called prokinetic, they cause the stomach contents to be pushed towards the intestine rather than be pushed up towards the esophagus. So the prokinetic drugs are almost exclusively used for the treatment of GERD. The agent can be a muscarinic agonist, but obviously that would cause all the cholinergic side effects. The anticholinesterase would have the same systemic side effects. The dopamine inhibitors (Reglan is a specific drug of this class) are very important, we’ll come back to them. Cisapride (a 5-HT agonist) has been withdrawn for deaths, there was discovered to be some drug interactions.


Metoclopramide (Reglan) has a distinct action. It acts on the dopaminergic D2 receptor, presynaptically, in the stomach. The net effect is the appropriate change in acetylcholine secretion, which would stimulate the smooth muscle to get the prokinetic effect. It is an indirect way to get the choline-mimetic effect. If you see a pt taking Reglan, its almost always used with a PPI in the management of GERD, not as a fixed combination, they must write two prescriptions.

Category: Pharmacology Notes