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Erythromycin vs Metoclopramide for Facilitating Gastric Emptying and Tolerance to Intragastric Nutrition in Critically Ill Patients

From the ¹ Department of Clinical Pharmacy, School of Pharmacy, and the ² Department of Anesthesiology, School of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado.

Address correspondence to: Robert MacLaren, PharmD, School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Academic Office 1, L15-1421, 12631 East 17th Avenue, PO Box 6511, Aurora, CO 80045; e-mail: rob.maclaren{at}uchsc.edu.

Background: The purpose of this study is to evaluate erythromycin vs metoclopramide for facilitating gastric emptying and tolerance to intragastric enteral nutrition (EN). Methods: Twenty critically ill patients with a gastric residual >150 mL while receiving EN were randomized to receive 4 intravenous doses of erythromycin 250 mg or metoclopramide 10 mg, each administered every 6 hours. Acetaminophen 975 mg was administered enterally at baseline and after the fourth dose. Acetaminophen peak plasma concentration (Cmax), concentration at 60 minutes (C₆₀), time to Cmax (Tmax), and area under the concentration-time curve from 0 to 60 minutes (AUC_0-60) were determined. Residual volumes and feeding rates were recorded. Results: Compared with baseline, erythromycin increased Cmax (9.5 ± 6.1 mg/L to 17.7 ± 11.9 mg/L, P < .01), C₆₀ (5.4 ± 3.5 mg/L to 12.9 ± 7.6 mg/L, P < .01), and AUC_0-60 (3.5 ± 3.0 mg·h/L to 12.5 ± 8.7 mg·h/L, P < .01), while metoclopramide increased only AUC_0-60 (4.4 ± 2.8 mg·h/L to 9.5 ± 3.8 mg·hr/L, P < .05). Neither agent significantly reduced Tmax. Both erythromycin and metoclopramide reduced residual volumes (122 ± 48 mL to 36 ± 48 mL, P < .01, and 103 ± 88 mL to 21 ± 23 mL, P < .05, respectively) and allowed increased feeding rates (17 ± 23 mL/h to 45 ± 21 mL/h, P < .05, and 14 ± 17 mL/h to 44 ± 22 mL/h, P < .05, respectively). Conclusions: Both agents facilitate tolerance to intragastric EN, but erythromycin may be more effective than metoclopramide for enhancing gastric motility.

Key Words: erythromycin • metoclopramide • gastric motility • enteral nutrition • gastric residual • intensive care • critical illness

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