Nausea and vomiting is a common symptom of many ailments like viral gastroenteritis, food poisoning, stress, or even motion sickness. When patients visit overworked doctors, they are often prescribed Reglan to ease their symptoms. Is Reglan the best choice for you?

What is Reglan and Why is it Prescribed?

Reglan is an antiemetic, a gastroprokinetic agent, and increases lower esophageal sphincter tone. Reglan is commonly prescribed for nausea, vomiting, gastroparesis, and reflux. The medication relieves gastroparesis and reflux by encouraging the stomach to empty its contents orderly into the small intestine.1 The medication works as a D2 receptor antagonist and a 5-HT4 receptor agonist signaling the pyloric sphincter to relax and allow gastric chyme to pass through easier.2 D2 receptors are also found in the chemoreceptor trigger zone within the medulla oblongata in the brain and when stimulated it causes the stomach and esophagus to contract upward by stimulating muscles in the chest and thoracic diaphragm and weakens the lower esophageal sphincter leading to nausea and vomiting.3

Common side effects of Reglan include restlessness, drowsiness, fatigue, and focal dystonia. Some people even experience blood pressure regulation dysfunction, tardive dyskinesia, akathisia, neuroleptic malignant syndrome, and systemic allergic reactions.4 Reglan crosses the blood-brain barrier resulting in CNS side effects.5

I find tardive dyskinesia is one of the most worrying side effects associated with Reglan. It is a disease in which the body has permanent, involuntary, and repetitive body movements. The FDA issued a black box warning on Reglan stating that there is a strong indication Reglan can cause tardive dyskinesia.6 The longer you take Reglan, and the quantity of the dose you consume creates a higher concentration of Reglan in the brain. If you are under twenty, you are also in a higher risk category to develop tardive dyskinesia.7 The next time your doctor discusses Reglan for your condition, you should weigh the pros and cons of the medication with your doctor, and take the lowest dose for the shortest amount of time possible.

Is There a “Safer” Drug Alternative?

Sadly, there appears to be a safer “dopaminergic” antagonist that is in use in the European Union, domperidone.

In Europe, there is a much safer drug called domperidone but unlike Reglan, it does not cross the blood-brain barrier.8 Most of the CNS side effects are absent with domperidone meaning much less risk. Sadly, domperidone is not available in the United States because the intravenous form of has been linked to an irregular heartbeat.9

A safer prokinetic and anti-nausea agent would be to use fresh ginger, or New Chapter Ginger Force (as long as you have a healthy gallbladder).

The next medication I will write about is the most common prescribed medicine for “improving” digestive health, Proton Pump Inhibitors!

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