Symptomatic management for gastroparesis: antiemetics, analgesics, and symptom modulators

Although prokinetic agents typically are used for gastroparesis, antiemetic, analgesic, and neuromodulatory medications may help manage nausea, vomiting, pain, or discomfort. Antiemetic benefits are supported by few case reports. An open series reported symptom reductions with transdermal granisetron in gastroparesis. Opiates are not advocated in gastroparesis because they worsen nausea and delay emptying. Neuromodulators have theoretical utility, but the tricyclic agent nortriptyline showed no benefits over placebo in an idiopathic gastroparesis study raising doubts about this strategy. Neurologic and cardiac toxicities of these medications are recognized. Additional controlled study is warranted to define antiemetic, analgesic, and neuromodulator usefulness in gastroparesis.