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Mosapride versus Metoclopramide in Critically Ill Patients with Enteral Feeding Intolerance: A Randomized,
Eman Mohamed Elmokadem1, Dina Khaled Abou El Fadl1, Ahmed M Bassiouny2,3
1Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt.
Background:
Enteral feeding intolerance (EFI) from delayed gastric emptying is common in critically ill patients, leading to poor outcomes. Mosapride, a selective 5-HT4 agonist, may be a safer, more effective alternative to metoclopramide, which has limited efficacy due to tachyphylaxis and adverse effects.
Objective:
To compare the safety and efficacy of mosapride with metoclopramide in reducing gastric residual volume (GRV) and improving enteral nutrition delivery in intensive care unit (ICU) patients with EFI.
Methods:
In this prospective, randomized, double-blind, double-dummy trial, 100 mechanically ventilated ICU patients with EFI were allocated to receive either mosapride (5 mg enterally every 8 hours plus IV placebo) or metoclopramide (10 mg intravenously every 8 hours plus enteral placebo) for 7 days. GRV was measured daily via ultrasonography. Nutritional adequacy was evaluated through daily caloric and protein intake, calculated from delivered versus prescribed enteral volume. Clinical scores; including Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), and the Modified Nutrition Risk in Critically Ill (mNUTRIC), as well as ICU length of stay were assessed. Adverse events were continuously monitored using a structured reporting tool.
Results:
The mosapride group demonstrated a more significant reduction in GRV from day 1 to day 7 (68.03% vs 39.87%, p<0.001) and higher enteral volume ratio (79.52% vs 69.48%, p<0.001). Target energy ratio was more frequently achieved in the mosapride group (86% vs 28%, p<0.001). Improvements in SOFA and mNUTRIC scores were significant only in the mosapride group. Adverse events were comparable between groups (p=0.643). ICU length of stay was non-significantly different between the two groups (p=0.051).
Conclusion:
Mosapride is more effective than metoclopramide in reducing GRV and enhancing enteral nutrition delivery in critically ill patients with EFI, with a favorable safety profile. These findings support its consideration as a prokinetic agent in this population.
Clinical Trial Registration:
NCT06826443.
Insights
Mosapride significantly reduced gastric residual volume and improved enteral nutrition delivery in critically ill patients with feeding intolerance. This selective 5-HT4 agonist offers a safer, more effective alternative to metoclopramide.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Pharmacology
Background:
- Enteral feeding intolerance (EFI) is prevalent in critically ill patients, often due to delayed gastric emptying, leading to adverse outcomes.
- Metoclopramide efficacy is limited by tachyphylaxis and side effects, necessitating safer alternatives.
- Mosapride, a selective 5-HT4 agonist, presents a potential therapeutic option for managing EFI.
Purpose of the Study:
- To compare the efficacy and safety of mosapride versus metoclopramide in critically ill patients experiencing EFI.
- To assess the impact of these agents on gastric residual volume (GRV) and enteral nutrition delivery.
- To evaluate clinical outcomes and safety profiles in an intensive care unit (ICU) setting.
Main Methods:
- A prospective, randomized, double-blind, double-dummy trial involving 100 mechanically ventilated ICU patients with EFI.
- Patients received either enteral mosapride or intravenous metoclopramide for 7 days.
- Daily GRV measurement via ultrasonography, nutritional adequacy assessment, clinical scoring (APACHE II, SOFA, mNUTRIC), and adverse event monitoring were performed.
Main Results:
- Mosapride demonstrated a significantly greater reduction in GRV (68.03% vs 39.87%) and a higher enteral volume ratio (79.52% vs 69.48%) compared to metoclopramide.
- The target energy ratio was achieved more frequently in the mosapride group (86% vs 28%).
- Significant improvements in SOFA and mNUTRIC scores were observed only in the mosapride group, with comparable adverse events and non-significantly different ICU length of stay.
Conclusions:
- Mosapride is more effective than metoclopramide in reducing GRV and improving enteral nutrition delivery in ICU patients with EFI.
- Mosapride exhibits a favorable safety profile, supporting its use as a prokinetic agent in this population.
- Further research can explore long-term outcomes and optimal dosing strategies for mosapride in critical care settings.
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