Selection of Prokinetics

Recomendations

• Journal of Parenteral and Enteral Nutrition acknowledge the clinical usefulness of prokinetic agents, but recognise that the evidence base is limited, as the majority of studies involve small numbers of patients, and use only surrogate endpoints
• Although there is no clear body of evidence, prokinetics are relatively cheap and, in general, safe. Prokinetics should be considered as an adjunct to improve nutrition on the intensive care unit
• some authors recommend that metoclopramide is used as a first-line agent. In contrast Nyugen et al believe that erythromycin is more efficacious than metoclopramide and should be used first line.
• combination of erythromycin and metoclopramide is an effective treatment
  option in those not responding to a single agent

References:

1. www.uptodate.com
2. Prokinetic drugs for feed intolerance in critical illness: current and potential therapies. Critical Care and Resuscitation 132 • Volume 11 Number 2 • June 2009
3. Prokinetic drugs in the intensive care unit: reviewing the evidence, K Grant, R Thomas. Volume 10, Number 1, January 2009 JICS
4. Prokinetic therapy for feed intolerance in critical illness: One drug or two? Crit Care Med 2007 Vol. 35, No. 11