Medication Use And Associated Adverse Effects Experience In Patients With Gastroparesis Symptoms: Survey Data From A Tertiary Referral Center

INTRODUCTION: Gastroparesis syndromes are often associated with symptoms of nausea, vomiting, abdominal pain, and bloating. While medications are frequently used to alleviate and manage these symptoms, comparative adverse effects of these medications is lacking. We aimed to assess both exposure of and adverse effects associated with medications used for gastroparesis in a single center. METHODS: An anonymous IRB approved survey was offered at tertiary referral GI motility center visits for patients with the symptoms of gastroparesis. The survey assessed demographics, GI symptoms, medication use, and adverse effects experienced and was done at the visit or mailed back. Open ended questions were used to prevent response bias for patients to report the adverse effects they experienced. RESULTS: There were a total of 62 patients (93.5% female) with the symptoms of gastroparesis that completed the survey. Patients most frequently were exposed to metoclopramide (71.0%), ondansetron (83.9%) and promethazine (72.6%). Of these medications, metoclopramide had the highest prevalence of adverse effects (26 of 45 patients-59.1%). Among patients exposed to metoclopramide, neurologic symptoms were reported in 10 of 44 patients (22.7%) and tardive dyskinesia in 3 of 44 patients (6.8%). The most commonly reported adverse effects of all drugs were neurologic symptoms with metoclopramide (10 of 44 patients-22.7%), insomnia with dexamethasone (2 of 9 patients-22.2%) and GI issues with erythromycin (7 of 26 patients-26.9%). Medications listed with the fewest side effects reported were ondansetron (10 of 52 patients-19.2%), aprepitant (0 of 4 patients-0%), hyoscine (3 of 19 patients-15.8%), and buspirone (1 of 8–12.5%) (See Table 1 for details). CONCLUSION: Medications used for patients with the symptoms of gastroparesis have a high prevalence of adverse effects. Compared with previously published data regarding many of these medications, this survey yielded a higher prevalence of adverse effects. While previous studies have reported adverse effects in approximately 25% of patients exposed to metoclopramide vs. 59.1% of patients reported by survey. Treatment algorithms for gastroparesis patients built on balancing adverse effects compared with efficacy are needed. Early integration of safe, complementary, integrative therapies may be one way to minimize patient exposure while preserving treatment efficacy. Larger survey data is needed to confirm and expand on this pilot data.Table 1.: Prevalence of overall adverse effects and most common adverse medication effects reported for 17 medications