Sometimes after we eat, our stomach feels full and bloated, right? It feels like the food is not going down our stomach. Or we experience discomfort like constant belching, heartburn, and vomiting. One reason for these things could be that your digestive system, that is, your intestines, is a little slow. Today, we are talking about a special class of medicines that come to the rescue at such times.
Simply put, what are these Prokinetic Agents?
Prokinetic agents are a type of medication that stimulates the muscles in your gastrointestinal tract to contract, or "push," and help move food along more easily.
Imagine, when we swallow food, the muscles from our esophagus to our stomach and intestines just contract and relax like a wave, pushing the food forward. We call this spontaneous process peristalsis . It's like squeezing and squeezing something inside a tube and sending it forward. Because this process happens properly, our body is able to absorb the nutrients it needs from food.
However, if for some reason this motility process is weakened, food can stay in the stomach for a long time. This can cause discomfort such as bloating, constipation, and heartburn. That's when medications called Prokinetic Agents help to give our intestines a little "push" and restore that process.
How does this medicine work inside the body?
Prokinetic agents work by stimulating the nerves in our intestines, causing the muscles to contract. This does a few key things:
- Increases contractions of the esophagus: This causes food to move quickly into the stomach.
- Strengthen the Lower Esophageal Sphincter (LES): This is the "gate" between our esophagus and stomach. When it weakens, stomach acid can flow back up into the esophagus. This is what we call heartburn, or GERD . Prokinetic medications tighten this gate and stop the acid from flowing back up.
- Increases stomach contractions: This allows food in the stomach to move more quickly into the small intestine. When the stomach empties quickly, there is less chance of it coming back up.
- Reduces the time it takes for the stomach to empty: This also helps a lot in controlling conditions like GERD mentioned above.
What conditions are prokinetic agents used for?
This type of medication is usually recommended by doctors in cases where other treatments have not yielded any relief, as these can have some side effects.
| Medical condition | Simply put... | How does this medicine help? |
|---|---|---|
| Gastroparesis | Digestion is delayed because the stomach muscles do not function properly. This condition is common in people with diabetes. | It increases stomach contractions, helping it empty faster. Metoclopramide is a major drug approved for this purpose. |
| GERD (heartburn/chest pain) | A long-term condition caused by stomach acid constantly flowing into the esophagus. | These medications are not a cure for GERD on their own. However, if delayed gastric emptying is also a cause of GERD, your doctor may prescribe them along with other medications. |
| Functional Dyspepsia | Continued symptoms of indigestion after eating, but no clear cause can be found. | It helps reduce symptoms by increasing stomach contractions, emptying it more quickly. |
| Nausea and vomiting | Persistent vomiting and nausea that are difficult to control with other treatments. It is also used to treat vomiting caused by chemotherapy given to cancer patients. | These symptoms are controlled by affecting the vomiting centers in the brain and speeding up gastric emptying. |
What are the main types of prokinetic agents?
These drugs can be divided into two main groups based on how they work: Agonists and Antagonists .
- Agonists: These act like neurotransmitters in our body and do the same thing they do. That is, they send the message to the muscles in the intestines to contract.
- Antagonists: These work by stopping a chemical that carries nerve messages that slow down the activity of the intestines from reaching a nerve. That is, they block the message that makes the intestines "slow down."
There are several categories of medications under this:
- Dopamine antagonists: Dopamine, a chemical found in the brain and intestines, reduces bowel function. These medications work by blocking the action of dopamine. Examples: Metoclopramide, Domperidone .
- Serotonin agonists: They act like a chemical called serotonin and stimulate intestinal contractions. Examples: Prucalopride .
- Motilin agonists: Motilin is a chemical that controls the contractions of our small intestine. This is how these drugs work. Surprisingly, this group includes antibiotics like Erythromycin .
- Cholinergic agonists: Act like the neurotransmitter acetylcholine and cause the muscles in the intestines to contract. Examples: Bethanechol, Neostigmine .
Extremely important: Side effects of this medication
This is the most important part of this article. Prokinetic Agents are not a medicine like Panadol for a common headache. They can have serious side effects and should not be taken for any reason without the advice of a doctor.
Doctors only prescribe these medications when other treatments have failed, and they are often given in low doses and for short periods of time.
Commonly seen side effects:
- Stomach ache
- Nausea and vomiting
- Diarrhea
- Blurred vision
- Headache
- Extreme fatigue, drowsiness
- Depression and Anxiety
Serious side effects to watch out for:
These symptoms are very important. If you experience any of these symptoms while taking a prokinetic medication, you should notify your doctor immediately.
- Dystonia: This is a condition in which the muscles in the body contract in an uncontrollable manner, such as the neck being pulled to one side, the eyes rolling up, or the tongue sticking out.
- Involuntary movements of facial parts (Tardive Dyskinesia): This is a condition that can occur after taking medication for a long time. Parts of the face, such as the mouth, tongue, and jaw, move involuntarily. This condition sometimes does not improve even after stopping the medication.
- Heart problems: Some medications, especially Domperidone , can cause irregular heartbeats (arrhythmias) and heart attacks. For this reason, the use of these medications has been restricted in some countries.
Because of these risks, if your doctor prescribes this medication, talk to him or her carefully about the pros and cons. Be sure to tell your doctor about any other medical conditions you have and any other medications you are taking.
Take-Home Message
- Prokinetic agents are a type of medication that gives a "push" to a "slow" digestive system, making food move more easily.
- These are used to treat conditions such as gastroparesis (stomach dysfunction) and severe GERD.
- These are rarely used as first-line treatments because of the risk of serious side effects.
- Never use these medications without medical advice.
- If you experience any unusual symptoms while taking this medicine, especially uncontrollable muscle twitching in the face or body, tell your doctor immediately.
- If your doctor has prescribed this medicine for you, it is because he or she has judged that the benefits are greater than the possible risks. Therefore, follow your doctor's instructions exactly.
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