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Side Effects of


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Description: Prokinetic drugs enhance gastric motility. They do this by increasing the frequency of contraction in the small intestine. In short, any drug that increases gastric motility is described as a prokinetic. These drugs can be used to treat disorders including irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD) and some instances of dyspepsia. (Journal of Neurogastroenterological Motilility “Prokinetics in the Management of Functional Gastrointestinal Disorders,” Mar 2015).

Common Side Effects of Prokinetics

Prokinetics are associated with a number of side effects, which can range from bothersome to serious. Common side effects include:

  • Difficulty speaking
  • Syncope (fainting)
  • Irritability
  • Heart palpitations
  • Itching (pruritus)
  • Hot flashes
  • Pain
  • Constipation
  • Change in appetite
  • Drowsiness
  • Extrapyramidal syndrome
  • Parkinsonism
  • Confusion
  • Asthenia
  • Amenorrhea
  • Hypersensitivity
  • Skin rash
  • (Therapeutic Advances in Drug Safety “Current issues on safety of prokinetics in critically ill patients with feed intolerance,” Oct 2011).

    Serious Side Effects of Prokinetics

    Serious adverse reactions to prokinetics include:

  • Agranulocytosis
  • Potentially fatal supraventricular tachycardia
  • Hyperaldosteronism
  • Neuroleptic malignant syndrome
  • Akathisia
  • Tardive dyskinesia
  • (Gastroenterology “The clinical pharmacology of motility disorders: the perils (and pearls) of prokinesia,” Apr 1994).

    Understand Your Risk for Side Effects with the Rxight® Genetic Test

    Identifying the polymorphisms in genes which code for the metabolism of medications is crucial for clinical decision-making. Clinicians may prescribe a patient a lower starting dose (or an entirely different drug) given the patient’s known polymorphisms. Unfortunately genomic screening is not performed as standard by most healthcare providers. MD Labs can fill this gap with its genomic screening program, Rxight®, which sequences more than 18 genes to establish how a patient is likely to respond to hundreds of medications across dozens of pharmacological classes (including prokinetic drugs). With the result of Rxight® pharmacogenetic testing, your prescriber(s) can determine the safest and most effictive dose for you based on your unique genetics, or find an alternative medication if needed.

    How Does Pharmacogenetic Testing Work?

    Some patients will not develop side effects when taking prokinetic drugs for gastrointestinal motility. However, others may suffer severe side effects. This interpatient variability is largely account for by pharmacogenetics ie how an individual’s genome interacts with the drugs one takes. Polymorphisms (individual variants) in some genes that code for receptors and enzymes that interact with prokinetic drugs can increase the probability of developing side effects.


    For instance, in pharmacotherapy with the prokinetic metoclopramide, a number of polymorphism have been associated with an increased in side effects. These polymorphisms were found in a number of genes: CYP2D6 (a cytochrome P450 isoenzyme), KCNH2 and 5-HT4 receptor gene. All these genes encode for receptors that interact with the drug, or enzymes that metabolize it. Poorer metabolism of an agent like metoclopramide can cause increased side effects, as patients have a higher blood concentration of the agent. Meanwhile, rapid metabolism can result in the medication being ineffective because it is cleared from the body rapidly. (Journal of Clinical Gateroenterology “Lessons from Pharmacogenetics and Metoclopramide: Towards the Right Dose of the Right Drug for the Right Patient,” Jul 2013).


    Contributors to this Article:
    Michael Sapko, MD, PhD; Deborah Kallick, PhD, Medicinal Chemistry


    Prokinetics Tested Include:

    Read more about Rxight® Genetic Testing For Medication Effectiveness