Table 3.
Trials of metoclopramide for gastroparesis
| Design | N, Etiology | Dose p.o. | Duration | Results | Reference |
|---|---|---|---|---|---|
| DB, PC, PG RCT | 28 patients: 5 DG, 4 vagotomy and pyloroplasty, and 19 IG | 10mg qid | 3 wk | Symptomatic benefit vs. placebo: mean TSS for metoclopramide:18.4 pre to 7.2 post-study; for placebo, 19.1 pre-to 12.9 post-study | Perkel 1979, ref. 58 |
| DB, PC, PG RCT | 55 patients: 21 vagotomy and drainage, 5 DM, 29 IG delayed GE | 10mg qid | 3 wk | Metoclopramide significantly decreased symptom scores of surgical and idiopathic patients | Perkel 1980, ref. 59 |
| DB, PC, XO, RCT | 10 DM | 10mg qid | 3 wk/arm | Improved symptoms and vomiting; ∼60% acceleration in GE liquid 150kcal meal | Snape 1982, ref. 60 |
| DB, PC, PG, RCT | 28: 5 DG, 4 PS, 19 IG | 10mg qid | 3 wk | Improved symptoms by 29% | Perkel 1979, ref. 58 |
| PC, RCT | 18 DG | 10mg qid | 3 wk | Improved symptom score by 29%, and GE by 25% | McCallum 1983, ref. 61 |
| DB, PC, XO, RCT | 13 DM with GE accelerated by i.m. metoclopramide | 10mg qid | 3 wk/arm | Improved symptoms with mean reduction of 52.6% | Ricci 1985, ref. 62 |
| DB, RCT | 45 diabetic, domperidone-controlled multicenter trial | 10mg qid | 4 wk | Improved symptoms by 39%; similar efficacy with domperidone which had less AEs | Patterson 1999, ref. 63 |
| DB, XO, RCT | 13 DG; erythromycin-controlled | 10mg tid | 3 wk/arm | Both treatments accelerated GE compared to baseline, and improved symptoms score | Erbas 1993, ref. 64 |
| Open | 1 diabetic | 15mg qid | 6 months | Improved symptoms, GE liquids, antral contraction frequency | Longstreth 1977, ref. 65 |
| Open | 10 GI symptomatic T1DM, 6 asymptomatic T1DM, 18 HC | 10mg i.v. | Single dose | Improved GE solids | Loo 1984, ref. 66 |
| Open, PG, RCT | 89 T1DM or T2DM gastroparesis | 10, 20mg spray or 10 mg tab qid | 6 weeks | Nasal 10 and 20 mg had lower TSS compared to oral 10 mg group; More side effects, especially nausea with oral | Parkman 2014, ref. 67 |
| DB, PC, PG, RCT | 285 T1DM 1 or T2DM with delayed GE or nausea and vomiting. | 10 or 14mg nasal spray qid | 4 weeks | Gastroparesis symptom scores were reduced significantly in female subjects, not in males. Adverse effects: dysgeusia, headache, and fatigue. | Parkman 2015, ref. 68 |
(Updated from ref. 1, Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. Clinical Guideline: Management of Gastroparesis. Am J Gastroenterol 2013;108:18–37); GE=gastric emptying; T1DM = type 1 diabetes mellitus AE=adverse event; DB=double-blind; DG=diabetic gastroparesis; DM=diabetic; GE=gastric emptying; GI=gastrointestinal; HC=healthy controls; IG=idiopathic gastroparesis; NA=not available; PC=placebo- controlled; PG=parallel group; PS=post-surgical gastroparesis; RCT=randomized controlled trial; T1DM=type 1 diabetes mellitus; T2DM=type 2 diabetes mellitus; TSS=total symptom score; XO=crossover