# Diabetic Gastroparesis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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) ## Treatment metadata - Metoclopramide — 10 mg — oral.solid - Domperidone — 10 mg — oral.solid - Erythromycin — 250 mg — oral.solid - Diphenhydramine — oral.solid - Ondansetron — 4 mg — oral.solid ## Complete treatment card ```text DIABETIC GASTROPARESIS 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 against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Nausea and vomiting are the most frequent symptoms and track with how delayed gastric emptying is [nausea · vomiting] - Feeling too full after eating and bloating are common, and weight loss shows up in severe, ongoing cases [abdominal distension · weight loss] - Vomit may still contain food eaten several hours earlier - Diabetic gastroparesis tends to bring more severe nausea and vomiting than the idiopathic form [nausea · vomiting] - Belly pain is common but rarely the main complaint; when it is the main complaint, another cause should be considered [abdominal pain] - Symptom severity does not reliably track with how delayed the stomach empties on testing, and some patients with a positive test have no symptoms at all SIGNS - what you find (2) - Exam may show upper-abdominal distension or tenderness, but without guarding or rigidity that would suggest a surgical abdomen [abdominal distension] - Look for signs of the underlying cause, such as diminished sensation from diabetic nerve damage, a tremor, or old surgical scars [scarring · tremor] TESTS (8) - Baseline bloodwork typically includes a metabolic panel, liver tests, a complete blood count, and lipase - CT or MRI of the abdomen helps exclude a mechanical blockage, such as from a tumor, as the cause of the vomiting - Upper endoscopy also helps rule out a blockage as the cause - A radiolabeled meal scan is the gold-standard test, graded by four-hour retention as mild under 15 percent, moderate 15 to 35 percent, and severe over 35 percent - Four-hour scan timing is more accurate than two-hour, and adding a liquid-meal study raises sensitivity when solid emptying looks normal - The breath test using a labeled meal is noninvasive, avoids radiation, correlates 73 to 95 percent with the scan, but is less reliable with liver or lung disease - The swallowed wireless motility capsule is 59 to 86 percent sensitive and 64 to 81 percent specific for the diagnosis - Gastric ultrasound is radiation-free and noninvasive, making it an option in children and pregnant patients IF NOT THIS - what else fits (6) - Functional dyspepsia looks very similar, and a formal emptying test is often needed to tell them apart - Gastric outlet obstruction looks similar but has an underlying mechanical blockage - Cyclical vomiting syndrome causes recurring bouts of severe nausea and vomiting lasting hours to days - Rumination syndrome is effortless regurgitation of undigested food shortly after eating, without the nausea that precedes gastroparesis - Cannabinoid hyperemesis syndrome causes episodic vomiting in heavy cannabis users, often eased by hot showers and resolving once cannabis stops - A psychiatric condition such as anxiety, anorexia nervosa, or bulimia can produce ongoing upper GI symptoms that mimic gastroparesis Source StatPearls "Gastroparesis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Antiemetic - sedating antihistamine | Antiemetic - when sedation is unacceptable MAIN TREATMENT - choose one 1. METOCLOPRAMIDE [1st line] Adult 10 mg orally three times daily 30 minutes before meals (max 5 days per EMA/EDA guidance) - Shortest duration necessary (max 5 days per EMA/EDA guidance for acute flares) Peds 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. Choice Alternatives. Metoclopramide is the only prokinetic approved for diabetic gastroparesis by both the FDA and the EDA. Limit to 5 days - tardive dyskinesia is the reason domperidone is often chosen instead. Source Metoclopramide 10mg SmPC (https://www.medicines.org.uk/emc/product/2355/smpc) Why 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. Caution 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. Egypt CLOPRAM 10MG 20 TAB. EL NASR 3.00 EGP (0.15/unit) PLEMAZOL 10MG 20 TAB. CID 3.20 EGP (0.16/unit) VOMAWAY 10MG 20 TAB. MEMPHIS 8.50 EGP (0.42/unit) PRIMPERAN 10MG 10 SCORED TAB. SANOFI 10.50 EGP 2. DOMPERIDONE [1st line] Adult 10 mg orally three times daily 15-30 minutes before meals (max 30 mg/day) - Shortest duration necessary (up to 7 days) Peds Pediatric diabetic gastroparesis requires specialist pediatric gastroenterology evaluation; domperidone use in children is restricted. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (domperidone monograph) Why 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. Caution 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. Egypt DOMPIDONE 10 MG 30 TAB. ARAB DRUG COM... 17.25 EGP (0.57/unit) SYNCHROGIT 10MG 20 TAB. RAMEDA 15.00 EGP (0.75/unit) MOTINORM 10MG 30 TABS. GLAXO SMITHKLINE 28.25 EGP (0.94/unit) GASTROMOTIL 10MG 20 F.C. TAB. EIPICO 26.00 EGP (1.30/unit) MOTILIUM 10MG 40 F.C.TAB. MINA PHARM > ... 100.00 EGP (2.50/unit) GASTRONORM 10MG 5 SACHET SIGMA 5.50 EGP MOTIL FAST 10 MG 10 EFF. SACHETS AMOUN 26.00 EGP DONARAX 10 MG 30 ORODISPERSIBLE TABS. JEDCO INT. CO. FOR PHARMACEUTICALS... 39.00 EGP DOMPIDONE 100MG/100ML ORAL SUSP. 100ML ARAB DRUG COMPANY (ADCO) 6.00 EGP -> ? strength differs, ? different route - not oral solid MOTILIUM 1MG/ML SUSP. 100ML MINA PHARM > ... 15.75 EGP -> ? strength differs, ? different route - not oral solid 3. ERYTHROMYCIN [2nd line] Adult 250 mg orally three times daily 30 minutes before meals - Short courses of 2-4 weeks Peds Pediatric diabetic gastroparesis is a rare manifestation of pediatric T1D requiring specialist pediatric endocrinology/gastroenterology management. Source StatPearls: Gastroparesis (NCBI Bookshelf NBK551528) Why 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. Caution 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. Egypt ERYTHROMYCIN STEARATE 250MG 10 F.C. TABS. HI-PHARM 6.50 EGP (0.65/unit) -> discontinued ERYTHROCIN 250 MG TAB. KAHIRA > ABBO... 3.75 EGP [discontinued] ANTIEMETIC - SEDATING ANTIHISTAMINE - give alongside 4. DIPHENHYDRAMINE [add-on - not a substitute] Adult 12.5 mg to 25 mg per dose, four times daily at most Peds No paediatric dose in the sources opened. Source Gastroparesis - StatPearls - NCBI Bookshelf (NBK551528) Why 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. Caution 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. Egypt SULTAN 50MG 20 CAPS. PHAROPHARMA 5.00 EGP (0.25/unit) ANTIEMETIC - WHEN SEDATION IS UNACCEPTABLE - give alongside 5. ONDANSETRON [add-on - not a substitute] Adult 4 mg or 8 mg per dose, three times daily at most Peds No paediatric dose for gastroparesis in the sources opened. Source Gastroparesis - StatPearls - NCBI Bookshelf (NBK551528) Why 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. Caution 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. Egypt DANOFRAN 4MG 5 F.C. TAB. UP PHARMA 70.00 EGP (14.00/unit) SETRONOMET 4 MG 4 ORAL DIS. TABS. AVERROES PHARMA 78.00 EGP IDIVOMTRON 4 MG 10 ORALLY DIS. TABS. INTERNATIONAL DRUG AGENCY (IDI) 144.00 EGP EMEREST 4 MG 10 ORO-DISPERSIBLE TABS. GLOBAL PHARMACEUTICAL INDUSTRIES 188.00 EGP IDIVOMTRON 4 MG/5ML SYRUP 50 ML RAMEDA > INTE... 110.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)