Gastroparesis
 

I began suffering from gastroparesis after a bad dysautonomic "flare" for which I was hospitalized last June (it was confirmed by endoscopy and a gastric emptying test).

I understand that small fiber neuropathy (autonomic) may be responsible. I am unsure if this is how I came to suffer from it but I am having quite a bit of difficulty in controlling it (pain, fullness, nausea).

The drugs Reglan and Zofran (or phenerghan) are prescribed for me but I am reluctant to take them, Reglan in particular as it has a black box warning.

Does anyone here suffer from GP? How do you manage it? Mere

Reglan is metoclopramide. It is a dopamine antagonist. I can cause tardive dyskenesia and middle age women seem to be most at risk for TD. Zofran is not the same. It is related to SSRIs. In some people, particularly those with dystonia, it can cause movement disorders, but in the vast majority of people, it is generally tolerated well. Phenergan is promethazine, an antihistamine.

All three can cause movement disorders because all of them suppress dopamine. It can exacerbate restless leg, arm, back syndrome. I tried Reglan and Zofran, IV, at the ER, and both caused me to have an exacerbation of my movement disorder, and the Zofran was the worst....unmitigated by pramipexole! I have dopamine issues, so I am not typical.

Some folks do just fine with these meds.

For me they had to use erythromycin. I am doing better now, in the GI dept. and dont seem to need anything...at least for now. Knock on wood.

I believe they can also implant a stimulator?

Thank you for the information Cyclelops. I am glad to hear that your tum has improved and that you are doing better with that aspect of your illness, it all counts...

That is just great that these meds can cause movement disorders :(. I am a middle aged woman and I suffer from restless leg although i am not treated for it. At least that's what I think it is. Sometimes, I get jumps and rhythmic jerks from my lower body. I can't control it.

I don't think that it is related to the meds as I have had the rhythmic jerks for years (long before the GP). I have never been prescribed erythromycin - perhaps it is worth a try...

Cyclelops, question for you... I used to take Mirapex for fibromyalgia but then had to discontinue it due to worsening of some of my 'dysautonomic' symptoms. Specifically, nasal congestion and flushing.

Mirapex is a dopamine agonist. Does dopamine directly affect the autonomic nervous system? The reason I wonder is that you mentioned the stomach drugs as being dopamine supressors. Just wondering if dopamine-targeted drugs may be a bad idea for me since my autonomic nervous system is 'out of whack'.

If you have suffered from restless leg, likely none of the dopamine ANTagonists will sit well with you. They are all likely to cause movement disorder.

Yes, Mirapex, or pramipexole does affect the autonomic system, but at the low doses generally used for RLS, 0.125 to 0.50mg, usually it is tolerable. It can cause nausea and hypotension.

It is a matter of weighing the good versus the bad. I have no choice since my RLS is so darn bad, I would die of exhaustion.

It doesn't pay to take a dopamine ANTagonist for your stomach and then a dopamine agonist for your stomach.

Most drugs are autonomically active....with the exception of some antibiotics. Even the -mycin drugs, can cause arrhythmias. They also gum up the cytochrome P450, 3A4 enzyme, which metabolizes many drugs, such as ambien, the benzos, and many others. Charts are available to see what drugs are metabolized by what enzyme.

I don't know what drugs you take, so it is hard to say if any of your meds could be causing gastroparesis. With autonomic neuropathy, drugs are generally not that easy to manage. It is really hard. You will have to look up all the actions and side effects. That is what I do. I have to remind docs who focus on only one system and tell them, well, that drug will do this to the other system. Then they usually say, 'oh your right'. Diltiazem for example is used for esophageal spasm, which I have. Sure it works fine in folks with no hypotension. I have hypotension usually....lately the BP has been labile. But, anyway, Diltiazem would stop esophageal spasm, but cause hypotension and I would go down like a rock.

When the autonomic nervous system goes, we have to manage all the usual functions of the body. I can't stand upright for too long.....my body prefers to recline. I have to fight that as much as I can, but I get breathless, dizzy and feel like passing out.

The less the better in terms of drugs.

Pain meds really knocked out my GI system. It is functioning nominally now with no pain meds, but, that is not easy for me. I am in a substantial amount of pain. I don't have a choice. My system won't function anymore.

If drugs won't do, perhaps they can put in a stimulator. If I am correct, they can insert some kind of pacer.

Thank you once again Cyclolops for your wealth of information... I was a bit confused about dopamine AGonists and ANTagonists. You clarified that beautifully. Fortunately, I do not have the rls (or, what ever that is) frequently. Fortunate and strange.

I see your point about weighing the benefits versus the risks of taking prescription medications with dysautonomia. I still have a lot to learn.

And, I can understand how difficult it must be for you to not take stronger analgesics. I am sure you must have lots of discomfort and pain with the Scleroderma, AN and PN... I used to take more narcotics but stopped them due to various reasons, one being excessive sleepiness. I still take a very low dose of narcotic med. at night because I have alot of pain from my arthritis - mostly large joint. Also take ambien at night, Verapamil for tachycardia, Humira (arthritis) and 3 mg of prednisone.

This is the prescription meds that I take.

I do suffer a whole lot of other pain from the neuropathies and have other pain meds I can take, but don't. It does definitely impact my stomach and the GP. I may need to cut the nighttime narcotic. It is my understanding that Verapamil also impacts GP but I cannot even imagine not taking that drug. Neurologist is okay with it for now but perhaps there is a better way to control the tachycardia.

I also feel the way you describe - worse upright. I have palpitations and tachycardia (even with the Verapamil), migraine headaches, variations in BP, variations in body temp., trouble with my bladder, flushing, trouble breathing, chest pains, near syncope, extreme tiredness etc., etc., I seem to have 'flares' of the 'dysautonomia'. Concurrrently, the sensory neuropathy flares. There is some degree of it with me all of the time but I definitely have some rough patches. Two tough ones last year, one hospitallization.

I certainly appreciate your information and I hope you are still feeling the positive effects of your last IVig treatment. Mere

I do hope you get some relief.

As far as my diagnosis, they have not diagnosed me with scleroderma, yet, altho my labs and many symptoms indicate that possibility. I carry a Sjogren's diagnosis....with the PN. Most autoimmune disease melts across diagnostic criteria.

If you don't have bad RLS, Zofran (ondansetron) is worth a try. That has less issues with permanent movement disorder than the Reglan type drugs.

Here is a more complete explanation of Reglan:

http://en.wikipedia.org/wiki/Metoclopramide

It is a complex drug with many actions, besides dopamine antagonism.

This link explains that using erythromycin with verapamil is not recommended.
http://en.wikipedia.org/wiki/Erythromycin

Hi Mrs D. I noticed in the above post a mention of mirapex causing sinus congestion. I wonder if you have any information to share on this. The last six months have been hellish and now my sinusitis is causing extreme sore throat and inabillity to sleep due to tickling. Saw the ENT doc twice. Took a course of antibiotics, which did not even touch it. Could it be related to mirapex? Feeling like I can hardly take it any longer! And advice appreciated. Thanks and Best Wishes TT

I cannot find much on the congestion issue on the net.
At Rxlist.com there is a chart showing at higher doses some congestion was reported. But it is not very much.

This drug is not available at Patientsville.com which is a site that commonly gives side effects and post marketing information on many drugs.

This site lists nasal congestion as a common side effect.
http://www.newsindexer.com/act/webpa...es/ue4948.html

I cannot find an explanation of how this works, and the chart at Rxlist.com does not give high incidence of it either.