The 5 Best Gastroparesis Medications and Over-the-Counter Treatments, Reviewed

If you live with gastroparesis — delayed stomach emptying — you know how painful and frustrating the condition can be. It’s thought that 10 men and 40 women out of every 100,000 people have gastroparesis. But, as many as 1 in 4 adults in the U.S. have similar symptoms to those experienced by people with gastroparesis.

After we eat, contractions of the stomach help to crush food and push it into the small intestine. Then, further digestion and nutrient absorption occur in the intestines. In people with gastroparesis, the stomach muscles don't work as well. So, food leaves the stomach more slowly. This can cause symptoms like nausea, vomiting, and stomach pain.

Gastroparesis can be caused by medical conditions. In fact, diabetes is a common cause of the condition (called diabetic gastroparesis). But it can also occur without a clear cause. 

If you have gastroparesis, there are several treatments available. In this article, we'll review five common prescription treatments for gastroparesis. We also cover over-the-counter (OTC) treatments, pain medications, and new gastroparesis medications on the horizon.

What are some commonly prescribed gastroparesis medications?

It may surprise you to hear that there aren't many medications FDA-approved to treat gastroparesis. In fact, only metoclopramide (Reglan) is approved to treat this condition. And it’s only approved to treat diabetic gastroparesis. But experts have also recommended other medications for this condition.

It’s important to note that these aren’t the only medications that can treat gastroparesis. These are just the most common ones.

1. Metoclopramide (Reglan)

Metoclopramide is a dopamine receptor antagonist. It’s also a prokinetic medication. This means it helps move food through the gastrointestinal (GI) tract (the stomach and intestines) faster. Metoclopramide works for gastroparesis by helping the stomach muscles have better contractions. It also relaxes the area where food leaves the stomach. This helps food to pass into the intestines quicker.

The usual dose of metoclopramide for gastroparesis is 10 mg by mouth 4 times daily. It’s suggested to take it 30 minutes before each meal and at bedtime for 2 to 8 weeks, but for no longer than 12 weeks (unless indicated).

2. Erythromycin

Erythromycin is a macrolide antibiotic that also has prokinetic effects. Both oral and intravenous (IV) forms have been studied to treat gastroparesis. Erythromycin works by causing food to empty out of the stomach at a faster rate. This lowers symptoms of gastroparesis. But, its effects seem to lessen after 4 weeks of treatment. So it’s best used for short periods of time.

Since this is an off-label use for erythromycin, the dose used may vary between healthcare providers. In a study that tested oral erythromycin for gastroparesis, the dose was 500 mg 4 times daily. For IV erythromycin, the dose studied was 3 mg per kg of body weight every 8 hours. The IV form of this medication would likely only be used in a hospital setting.

3. Domperidone

Domperidone is a dopamine receptor antagonist and prokinetic, like metoclopramide. Domperidone seems to work as well as metoclopramide for treating symptoms of gastroparesis. It also seems to have fewer nerve and brain-related side effects compared to metoclopramide.

Domperidone isn’t FDA-approved for any use in the U.S. But your healthcare provider can submit a request for an exception. If granted an exception, you’ll only be able to fill it through certain pharmacies. Generally, people must try other gastroparesis medications before the FDA will allow you to get domperidone.

The starting dosage of domperidone for gastroparesis is 10 mg by mouth 3 times daily. If needed, the dosage can be raised to 20 mg by mouth 4 times daily.

4. Promethazine

Promethazine is an antihistamine medication that can be used as an antiemetic. An antiemetic is a medication that can help treat nausea and vomiting. It’s thought that promethazine works by blocking the action of a chemical called histamine in the body. Although it can help with nausea, it doesn’t affect gastric emptying like prokinetics.

The usual dose of promethazine for nausea is 12.5 mg to 25 mg every 4 to 6 hours as needed. You can take promethazine by mouth, rectally, or have it injected into a muscle.

5. Ondansetron (Zofran)

Ondansetron (Zofran) is another antiemetic medication that can be used to treat nausea from gastroparesis. It works by blocking the actions of serotonin (a chemical messenger) in the body. Similar to promethazine, it doesn’t affect how fast your stomach empties.

The usual dose of ondansetron for this use is 4 mg to 8 mg by mouth every 8 hours, as needed.

What OTC treatments help gastroparesis?

There are also some OTC treatments that may help with gastroparesis symptoms. But you should always check with your healthcare provider before starting a new medication or supplement — even if it’s OTC.

Acid blockers are one choice to reduce stomach acid. Examples include proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs). These can be helpful if gastroparesis is causing indigestion or heartburn symptoms.

Some people may wonder if probiotics help with gastroparesis. The science isn’t clear on whether they’re helpful. One study found that probiotics might be helpful for improving delayed stomach emptying. But larger studies are needed to confirm these benefits. Plus, some experts report that taking probiotics might worsen bloating caused gastroparesis.

Besides medication, you could try some lifestyle changes to improve your symptoms. Eating smaller meals and avoiding high-fat or high-fiber foods can help. Avoiding trigger foods, like carbonated beverages and spicy foods, can also help to lessen symptoms. Getting regular exercise can also be beneficial.

What are the best pain medications for gastroparesis?

Abdominal pain is one of the key symptoms of gastroparesis. There are a few different types of pain medications that your healthcare provider might recommend.

Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Motrin, Advil), can help ease pain from gastroparesis. Many NSAIDs are available OTC. But they do carry a risk of stomach bleeding. So be sure to discuss how long to use these medications with your provider.

Tricyclic antidepressants (TCAs), like amitriptyline, may also be helpful for stomach pain. Some healthcare providers find they can ease gastroparesis pain.

Are there new medications being developed for gastroparesis?

Yes, there are several new gastroparesis medications currently being developed.

Some new medications under development for gastroparesis include:

• 5-HT4 agonists, which act on certain serotonin receptors (chemical binding sites) and speed up gastric emptying

• Relamorelin, which improves the action of stomach muscles

• Trazpiroben, a dopamine receptor antagonist that helps people feel more comfortable after eating

• Tradipitant, which blocks neurokinin-1 receptors in the brain, blocking a chemical that causes nausea from binding to them

• Acotiamide, which speeds up GI movement

All these medications are in various stages of development, including human clinical trials.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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