Lorna Kemble Pregnancy and Birth

2511 Other prokinetic agents

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Pharmacology and toxicology

Metoclopramide, bromopride, cisapride, and domperidon are licensed for treating motility disturbances in the upper intestinal tract. Dexpanthenol is used for intestinal atonia. Metoclopramide is discussed in Chapter 2.4. In a prospective, controlled multicenter study, the authors concluded that exposure to cisapride during pregnancy was not associated with an increased risk of malformations or other adverse effects, although the sample size (88 first-trimester exposures) is too small to draw conclusions as yet (Bailey 1997). Cisapride has been withdrawn from the market in some countries because of serious side effects such as fatal cardiac arrhythmias.

Experience in the use of bromopride and domperidon during pregnancy is insufficient for a well-grounded risk assessment.

Recommendation. Metoclopramide is the drug of choice for motility disturbances (with nausea) in the upper gastrointestinal tract. An (accidental) use of the other agents does not require termination of pregnancy or Invasive diagnostic procedures.