Table 58-9.
Mechanisms, Sites of Activity, Indications, and Doses of Currently Available Gastrointestinal Prokinetic Agents
| Drug Classification/Mechanism | Sites of Activity | Indications | Dose | Other properties |
|---|---|---|---|---|
| Dopaminergic D2 Antagonist Drugs | ||||
| Metoclopramide | GES, stomach, intestine, CRTZ | Vomiting disorders, gastroesophageal reflux, delayed gastric emptying, ileus/pseudoobstruction | 0.2 to 0.5 mg/kg PO, IV TID; 0.01 to 0.02 mg/kg/h infusion | α2-Adrenergic antagonist β2-Adrenergic antagonist 5-HT4 serotonergic agonist 5-HT3 serotonergic antagonist |
| Domperidone | GES, CRTZ | Vomiting disorders, gastroesophageal reflux | 0.05 to 0.10 mg/kg PO BID | α2-Adrenergic antagonist β2-Adrenergic antagonist |
| Serotonergic 5-HT4 Agonist Drugs | ||||
| Mosapride | Stomach | Delayed gastric emptying | 0.25 to 1.0 mg/kg PO BID | None |
| Prucalopride | Stomach, colon | Delayed gastric emptying, constipation | 0.01 to 0.20 mg/kg PO BID | None |
| Cisapride* | GES, stomach, intestine, colon, CRTZ | Gastroesophageal reflux, delayed gastric emptying, ileus/pseudoobstruction, constipation, chemotherapy-induced vomiting | 0.1 to 0.5 mg/kg PO TID (doses as high as 0.5 to 1.0 mg/kg have been used in some dogs) | 5-HT3 serotonergic antagonist 5-HT1 serotonergic antagonist 5-HT2 serotonergic agonist |
| Tegaserod* | Intestine, colon | Constipation, ileus/pseudoobstruction | 0.05 to 0.10 mg/kg PO or IV, BID | 5-HT1 serotonergic antagonist |
| Motilin-Like Drugs | ||||
| Erythromycin | GES, stomach, intestine, colon | Gastroesophageal reflux, delayed gastric emptying, constipation (dogs) | 0.5 to 1.0 mg/kg PO IV TID | 5-HT3 serotonergic antagonist |
| Acetylcholinesterase Inhibitors and Cholinomimetic Agents | ||||
| Ranitidine | Stomach, colon | Delayed gastric emptying, constipation | 1 to 2 mg/kg PO BID-TID | H2 histaminergic antagonist |
| Nizatidine | Stomach, colon | Delayed gastric emptying, constipation | 2.5 to 5.0 mg/kg PO SID | H2 histaminergic antagonist |
| Bethanechol | Esophagus | Canine idiopathic megaesophagus | Dog: 5 to 15 mg/dog PO TID | |
| Nitric Oxide Donors | ||||
| AMU-301 | Stomach | Diabetic gastroparesis | Not yet established | |
| Prostanoids | ||||
| Misoprostol | Colon | Constipation | Dog: 2 to 5 µg/kg PO TID-QID | |
CRTZ, chemoreceptor trigger zone; GES, gastroesophageal sphincter.
*
Removed from many international markets.