Sustol vs. Reglan for Heartburn: Important Differences and Potential Risks.

Key takeaways

Sustol (granisetron) and Reglan (metoclopramide) are both used to treat nausea and vomiting, but they have some important differences. Sustol is an antiemetic that works by blocking serotonin, while Reglan is a dopamine antagonist that speeds up gut movements. Sustol is given as an injection by a healthcare provider and lasts up to 7 days, whereas Reglan is taken by mouth multiple times a day. Sustol is only available as a branded medication, while Reglan comes as a lower-cost generic. Common side effects of Sustol include injection site reactions and constipation, while Reglan can cause drowsiness and restlessness. Sustol can interact with medications that increase serotonin levels and increase the risk of serotonin syndrome, while Reglan can increase the risk for tardive dyskinesia, a serious movement disorder.

Sustol

(granisetron)

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Metoclopramide

(Reglan)

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Summary for Sustol

Prescription only

Sustol (granisetron) is a medication used to prevent nausea and vomiting due to cancer medications (chemotherapy) in adults. It can last for up to 7 days.

Indications for Sustol

Prevention of nausea and vomiting caused by chemotherapy

Pros and Cons for Sustol

Pros

Works well for preventing nausea
Lasts for up to 7 days
Good option for people who have a hard time taking pills

Cons

Must be given by a healthcare provider as an injection under the skin
Not clear how safe the medication is in pregnant or breastfeeding females
Can't be used in children

Common Side Effects for Sustol

Injection site reactions, such as bruising, redness, or swelling (37-62%)
Constipation (14-22%)
Weakness or lack of energy (11-21%)
Headache (9-13%)
Diarrhea (8-9%)
Stomach pain (7%)

Warnings for Sustol

Injection site reactions
Serotonin syndrome
Severe allergic reactions
Stomach problems

Summary for Reglan

Prescription only

Metoclopramide (Reglan) is FDA-approved to treat gastroesophageal reflux disease (GERD), as well as gastroparesis in people with diabetes. Providers might also prescribe it off-label for morning sickness during pregnancy and nausea and vomiting caused by chemotherapy. But metoclopramide (Reglan) isn’t a first-choice medication for these conditions because it has a black box warning for a serious side effect called tardive dyskinesia. Metoclopramide (Reglan) can interact with some commonly prescribed medications, such as risperidone (Risperdal) and quetiapine (Seroquel).

Indications for Reglan

Delayed stomach-emptying caused by diabetes (diabetic gastroparesis)
Severe acid reflux (gastroesophageal reflux disease or GERD) when other medications haven’t worked

Pros and Cons for Reglan

Pros

Available as a lower-cost generic medication
Available in many forms including tablet, fast-melting tablet, liquid, nasal spray, and injection
Typically starts to work in 30 minutes to 1 hour
A possible option during pregnancy

Cons

Shouldn’t be used in children or for more than 12 weeks because of a higher risk of serious side effects
Needs to be taken multiple times a day
Interacts with a lot of medications such as antipsychotics, antidepressants, and opioids
Can't be used if you have Parkinson's disease, seizures, or stomach blockages or bleeds

Common Side Effects for Reglan

Restlessness (10%)
Drowsiness (10%)
Lack of energy (10%)
Tiredness (10%)

Warnings for Reglan

Difficulty controlling muscle movements (tardive dyskinesia)
Other conditions with uncontrolled muscle movements (dystonia, Parkinsonian symptoms, and restlessness)
Neuroleptic malignant syndrome (NMS)
Depression and suicidal thoughts and behavior
High blood pressure
Swelling in arms, legs, or around the belly
High prolactin levels