Diabetic Enteropathy: From Molecule to Mechanism-Based Treatment

Table 2

Prokinetic for treatment of diabetic gastroparesis.

Drug	Mode of action	Recommended daily dose (formulation)	Comment
Metoclopramide	5-HT4 receptor agonist; D2-receptor antagonist	10 mg TID (tablet)	Black box warnings for long-term use: (i) FDA < 3 months; (ii) EMA ≤ 5 days
Domperidone	D2-receptor antagonist	10 mg TID (tablet); 30 mg BID (suppository)	Should be avoided in the presence of prolonged QT interval
Erythromycin	Motillin receptor agonist; Cholinergic receptor agonist	250 mg TID (tablet)	Clinical efficacy often diminishes after 2–4 weeks due to tachyphylaxia; Prokinetic action likely a drug class effect and other macrolides with less toxicity may be used (azithromycin, clarithromycin), but evidence from controlled trials is lacking
Prucalopride	5-HT4 receptor agonist	2 mg (tablet)	Currently under investigation for diabetic gastroparesis in phase III trials. May be used off-label in selected cases
Granisetron	5-HT3 receptor agonist	3.1 mg per 24 hours (patch)	Evidence from controlled trials is lacking in diabetic gastroparesis