PHARMACOLOGICAL AND CLINICAL MODIFICATION OF PROKINETIC AGENTS

In the treatment of gatrointestinal motility disorders 3 prokinetic ag ents are principally available. Ther are differentiated from their pha rmacological mode of action, their clinical efficacy and tolerability. Metroclopramide is an antidopaminergic benzamide with mainly antiemet ic effects and minor prokinetic efficacy in the GI-Tract. Domperidon i s a pure dopaminantagonist. It accelerates gastric emptying but has le ss effect on bowel motility. Cisapride stimulates indirect the secreti on of acetylcholine and acts via 5 HT-receptors selective at the plexu s myentericus. These pharmacological differences have clinical relevan ce: metoclopramide and domperidon could not consistently prove efficac y in functional dyspepsia and GORD. In addition the data in other indi cations are rare. Only cisapride has shown significant responderrates in controlled studies in the treatment of gastrointestinal motility di sorders particularly in long term treatment. As concerns tolerability cisapride presents a progress by its selective mode of action in contr ast to the agents crossing the blood-brain-barrier.