{ "schema_version": 1, "kind": "condition", "id": "diabetic-gastroparesis", "name": "Diabetic Gastroparesis", "category": "chronic", "sources": "ADA Standards of Care in Diabetes 2024 · Egyptian National Drug Formulary (Gastrointestinal Tract Chapter 2026) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (domperidone monograph) · Metoclopramide 10mg SmPC (https://www.medicines.org.uk/emc/product/2355/smpc) · StatPearls: Gastroparesis (NCBI Bookshelf NBK551528) · Gastroparesis - StatPearls - NCBI Bookshelf (NBK551528)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (domperidone monograph) · Metoclopramide 10mg SmPC (https://www.medicines.org.uk/emc/product/2355/smpc) · StatPearls: Gastroparesis (NCBI Bookshelf NBK551528)", "verified_date": "2026-08", "treatments": [ { "id": 596, "generic": "Metoclopramide", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg orally three times daily 30 minutes before meals (max 5 days per EMA/EDA guidance)", "adult_duration": "Shortest duration necessary (max 5 days per EMA/EDA guidance for acute flares)", "dose_source": "Metoclopramide 10mg SmPC (https://www.medicines.org.uk/emc/product/2355/smpc)", "rationale": "Metoclopramide is the only FDA and EDA approved prokinetic agent for diabetic gastroparesis, but treatment duration is strictly limited to minimize risk of extrapyramidal movement disorders.", "cautions": [ "BLACK BOX WARNING for tardive dyskinesia (irreversible involuntary movements), especially with prolonged treatment (>12 weeks) or in elderly patients.", "Contraindicated in gastrointestinal hemorrhage, mechanical obstruction, perforation, or pheochromocytoma.", "Discontinue immediately if extrapyramidal symptoms, acute dystonia, parkinsonism, or akathisia occur." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Contraindicated in children under 1 year; restricted because of the extrapyramidal risk. The Egyptian National Drug Formulary - Gastrointestinal Tract, metoclopramide monograph, lists among its contra-indications any use in a neonate or in a child below 1 year, on the grounds of a raised risk of extrapyramidal disorders and of methaemoglobinaemia.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CLOPRAM 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 3.0, "pack_count": 20, "unit_price": 0.15, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PLEMAZOL 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 3.2, "pack_count": 20, "unit_price": 0.16, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOMAWAY 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.5, "pack_count": 20, "unit_price": 0.42, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PRIMPERAN 10MG 10 SCORED TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-gastroparesis" }, { "id": 597, "generic": "Domperidone", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg orally three times daily 15-30 minutes before meals (max 30 mg/day)", "adult_duration": "Shortest duration necessary (up to 7 days)", "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (domperidone monograph)", "rationale": "Domperidone does not cross the blood-brain barrier and carries a significantly lower extrapyramidal risk than metoclopramide, making it widely prescribed in Egyptian practice despite cardiac precautions.", "cautions": [ "Associated with small risk of serious ventricular arrhythmias and sudden cardiac death, particularly in patients >60 years or taking doses >30 mg/day.", "Contraindicated in patients with baseline QT prolongation, significant electrolyte disturbances, or underlying cardiac disease.", "Avoid co-administration with potent CYP3A4 inhibitors (e.g. ketoconazole, erythromycin, clarithromycin) due to elevated plasma levels.", "Off-label for this. The Egyptian formulary lists exactly one indication for domperidone - relief of the symptoms of nausea and vomiting - and gastroparesis is not among them. The dose here is the formulary's; the indication is not." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Pediatric diabetic gastroparesis requires specialist pediatric gastroenterology evaluation; domperidone use in children is restricted.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DOMPIDONE 10 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 17.25, "pack_count": 30, "unit_price": 0.57, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SYNCHROGIT 10MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 15.0, "pack_count": 20, "unit_price": 0.75, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOTINORM 10MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 28.25, "pack_count": 30, "unit_price": 0.94, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GASTROMOTIL 10MG 20 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 26.0, "pack_count": 20, "unit_price": 1.3, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOTILIUM 10MG 40 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > JANSSEN CILAG", "price_egp": 100.0, "pack_count": 40, "unit_price": 2.5, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GASTRONORM 10MG 5 SACHET", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 5.5, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOTIL FAST 10 MG 10 EFF. SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 26.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DONARAX 10 MG 30 ORODISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JEDCO INT. CO. FOR PHARMACEUTICALS > ARAX PHARM. IND.", "price_egp": 39.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOMPIDONE 100MG/100ML ORAL SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 6.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "MOTILIUM 1MG/ML SUSP. 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > JANSSEN CILAG", "price_egp": 15.75, "pack_count": null, "unit_price": null, "strength_mg": 1.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-gastroparesis" }, { "id": 598, "generic": "Erythromycin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 250.0, "adult_dose": "250 mg orally three times daily 30 minutes before meals", "adult_duration": "Short courses of 2-4 weeks", "dose_source": "StatPearls: Gastroparesis (NCBI Bookshelf NBK551528)", "rationale": "Macrolide antibiotic that also acts as a motilin receptor agonist, stimulating gastric motility and emptying in diabetic gastroparesis; used as an alternative when domperidone cannot be given, since the two must never be combined because of additive QT-prolongation risk.", "cautions": [ "Erythromycin is not obtainable in Egypt in this form. Every erythromycin eye product is absent from the national product list entirely, all 16 oral products are marked withdrawn, and the only three live topical products are acne preparations. Metoclopramide and domperidone are the line-1 options and both are stocked.", "Never with domperidone, which is the line-1 option above. Erythromycin is a potent CYP3A4 inhibitor and the Egyptian formulary lists the combination as an absolute contraindication, not a caution - both drugs prolong the QT interval on their own. Stop one before starting the other.", "Acts as a motilin receptor agonist to promote gastric emptying, but rapid tachyphylaxis (loss of prokinetic efficacy) occurs within 2-4 weeks due to receptor downregulation.", "May cause abdominal cramps, nausea, diarrhea, and QT interval prolongation.", "Potent CYP3A4 inhibitor; review concurrent medications for significant drug-drug interactions.", "The '30 minutes before meals' timing is conventional practice; the source does not state it." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Pediatric diabetic gastroparesis is a rare manifestation of pediatric T1D requiring specialist pediatric endocrinology/gastroenterology management.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ERYTHROMYCIN STEARATE 250MG 10 F.C. TABS. (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 6.5, "pack_count": 10, "unit_price": 0.65, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null }, { "trade_name": "ERYTHROCIN 250 MG TAB. (N/A)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA > ABBOTT LABORATORIES", "price_egp": 3.75, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": true, "also_contains": null } ], "condition_id": "diabetic-gastroparesis" }, { "id": 599, "generic": "Diphenhydramine", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": null, "adult_dose": "12.5 mg to 25 mg per dose, four times daily at most", "adult_duration": null, "dose_source": "Gastroparesis - StatPearls - NCBI Bookshelf (NBK551528)", "rationale": "The card carries prokinetics that speed the stomach up but nothing for the nausea itself; a sedating antihistamine is the cheapest of the three antiemetics the article names and the easiest to get in Egypt.", "cautions": [ "It is strongly sedating - warn against driving and against combining it with alcohol or other sedatives.", "It is also anticholinergic, and anticholinergics slow gastric emptying, so use it for the nausea and not as a standing drug; if the bloating and fullness worsen, stop it.", "Older patients tolerate it badly - confusion, urinary retention and falls.", "Give it for symptom relief alongside the prokinetic, not instead of it." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose in the sources opened.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SULTAN 50MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": 20, "unit_price": 0.25, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-gastroparesis" }, { "id": 600, "generic": "Ondansetron", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 4.0, "adult_dose": "4 mg or 8 mg per dose, three times daily at most", "adult_duration": null, "dose_source": "Gastroparesis - StatPearls - NCBI Bookshelf (NBK551528)", "rationale": "An antiemetic that does not sedate and does not slow the stomach, which makes it the better choice than an antihistamine for a working adult who still has to drive.", "cautions": [ "Never give a single dose above 16 mg - the risk of QT prolongation rises with the dose.", "Take extra care in anyone with a known long QT, an electrolyte disturbance, or on other QT-prolonging drugs, and remember diabetic patients on several medicines often are.", "Constipation and headache are the usual complaints.", "It settles the nausea without emptying the stomach, so keep the prokinetic going." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "No paediatric dose for gastroparesis in the sources opened.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DANOFRAN 4MG 5 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UP PHARMA", "price_egp": 70.0, "pack_count": 5, "unit_price": 14.0, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SETRONOMET 4 MG 4 ORAL DIS. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA", "price_egp": 78.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IDIVOMTRON 4 MG 10 ORALLY DIS. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG AGENCY (IDI)", "price_egp": 144.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EMEREST 4 MG 10 ORO-DISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES", "price_egp": 188.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IDIVOMTRON 4 MG/5ML SYRUP 50 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > INTERNATIONAL DRUG AGENCY (IDI)", "price_egp": 110.0, "pack_count": null, "unit_price": null, "strength_mg": 4.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "diabetic-gastroparesis" } ] }