American Board of Internal Medicine (ABIM) Certification Practice Exam

What medication is FDA approved for treating gastroparesis, but has side effects requiring discontinuation?

1. Metoclopramide

2. Domperidone

3. Cisapride

4. Proton pump inhibitors

The correct answer is: Metoclopramide

Metoclopramide is an FDA-approved medication for the treatment of gastroparesis, a condition characterized by delayed gastric emptying. It functions as a prokinetic agent, enhancing gastric motility and reducing symptoms such as nausea, vomiting, and abdominal discomfort. Despite its efficacy, metoclopramide is associated with significant side effects, particularly when used for extended periods or at high doses. One of the most serious side effects is tardive dyskinesia, a disorder that causes involuntary, repetitive body movements and can be irreversible. Additionally, patients may experience sedation, fatigue, and gastrointestinal disturbances. These adverse effects can lead to the need for medication discontinuation, which is a consideration in the clinical management of patients with gastroparesis. Other options like domperidone, while effective in symptom relief and generally better tolerated, are not FDA approved in the United States for this indication. Cisapride has been withdrawn from the market due to serious cardiovascular side effects, and proton pump inhibitors, while helpful for acid-related conditions, do not directly address the motility issues seen in gastroparesis. Thus, metoclopramide stands out as the medication that is FDA approved for treating gastroparesis,