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    Prokinetic Agents

    In a healthy human esophagus, swallowing induces primary peristalsis. These are the contractions that move your food down your esophagus and through the rest of your digestive system. In turn, gastroesophageal reflux provokes a second wave of muscular contractions that clears the esophagus, pushing food down through the lower esophageal sphincter (LES) and into the stomach.

    However, in some people, the LES either relaxes or opens spontaneously, allowing stomach contents, including acids, to reenter the esophagus. This is called acid reflux and may lead to symptoms like heartburn.

    Prokinetic agents, or prokinetics, are medications that help control acid reflux. Prokinetics help strengthen the lower esophageal sphincter (LES) and cause the contents of the stomach to empty faster. This allows less time for acid reflux to occur.

    Today, prokinetics are typically used with other gastroesophageal reflux disease (GERD) or heartburn medications, such as proton pump inhibitors (PPIs) or H2 receptor blockers. Unlike these other acid reflux medications, which are generally safe, prokinetics may have serious, or even dangerous, side effects. They’re often only used in the most serious cases of GERD.

    For example, prokinetics might be used to treat people who also have insulin-dependent diabetes, or infants and children with significantly impaired bowel emptying or severe constipation that doesn’t respond to other treatments.

    What Is Nausea & Vomiting?

    According to Woodruff (1997), nausea is the unpleasant, subjective feeling of the need to vomit.  Whereas, vomiting is the forceful release of stomach contents through the mouth caused by strong contractions of the stomach muscles.  Unfortunately, certain chemotherapy drugs can cause nausea and vomiting.  Luckily, there are many drugs that your doctor can prescribe to prevent, lessen, or relieve the nausea and vomiting associated with chemotherapy.  These medications are called anti-nausea drugs or anti-emetics.  These are a group of medications that can be used to control nausea and vomiting and can be given in different ways.  For example, if you are unable to keep anything down, don't worry because the drugs can be given through an I.V. catheter, a patch, rectally, under the tongue, or even in a shot if you cannot swallow.  Also, there are several things that patients with these symptoms can do to help themselves feel better besides medications.
     

    Things You Can Do to Guard Against Nausea:

    Ask questions:

    • Ask your health care professional to explain to you the chemotherapy drug(s) you will be taking, and the likely side effects of the drug(s).
    • Find out if the chemotherapy drug(s) are likely to cause nausea and vomiting.
    • If so find out when that is likely to occur and how long it typically lasts.  For example, will it start during chemotherapy or not until several hours later.
    • Ask what your doctor will be prescribing to prevent and control nausea and vomiting.  Learn how, when, and how often to take these medications.

    Fluids:

    • Drink fluids throughout the day like water and juices.  Many persons on chemotherapy need to drink at least two quarts of fluids per day.  Ask your doctor or nurse if this applies to you.  Also, if you are vomiting it is important to replace the fluids lost to avoid getting dehydrated.
    • Avoid drinking liquids at meals. 

    Eating hints:

    • Eat small amounts of food throughout the day.  
    • Eat before you get too hungry.
    • Eat dry foods such as dry cereal, toast, or crackers without liquids especially first thing in the morning.
    • Avoid heavy, high fat and greasy meals right before chemotherapy.
    • Do not eat your favorite foods during this time.  They will no longer be favorite foods if you begin to associate them with nausea and vomiting episodes.

    Surroundings:

    • Avoid strong odors.  
    • Don't lay flat for at least two hours after eating.  Rest by sitting up or reclining with your head elevated.
    • Fresh air and loose clothing may be helpful after eating.  
    • Exercising after eating may slow down digestion and increase discomfort.

    Distraction:

    • Relax and try to keep your mind off the chemotherapy. Bring soothing music, relaxation tapes, or CD's, with you to chemo.  Perhaps you would like to bring a funny movie to watch during chemotherapy and/or a friend or family member to keep you company.

    Other ways to minimize chemotherapy nausea: 

    • If you are vomiting, stop eating.  Once you stop vomiting, start back on food slowly.  Start with small amounts of clear liquids, such as broth, juice soda, sports drinks, or water.   Then, advance to light, mild foods like jell, bananas, rice, or toast.  Soon, you will be back to solid foods.  
    • Avoid caffeine and smoking.
    • Suck on hard candy, popsicles, or ice during chemotherapy.
    • Take the medications for nausea and vomiting as prescribed by your doctor.  If you are running low, ask for a refill.
    • Notify your nurse or doctor if you feel nauseated during chemotherapy.

    Proton-pump inhibitors are a group of drugs whose main action is a pronounced and long-lasting reduction of stomach acid production. Within the class of medications, there is no clear evidence that one agent works better than another.

    Taking Your PPIs

    PPIs are taken by mouth. They are available as tablets or capsules. Commonly, these medicines are taken 30 minutes before the first meal of the day.

    You can buy some brands of PPIs at the store without a prescription. Talk to your health care provider if you find you must take these medicines on most days. Some people who have acid reflux may need to take PPIs every day. Others may control symptoms with a PPI every other day.

    If you have a peptic ulcer, your doctor may prescribe PPIs along with 2 or 3 other medicines for up to 2 weeks. Or your provider may ask you to take these drugs for 8 weeks.

    If your provider prescribes these medicines for you:

    Take all your medicines as you are told.

    Try to take them at the same time each day.

    DO NOT stop taking your medicines without talking with your provider first. Follow up with your provider regularly.

    Plan so that you do not run out of medicine. Make sure you have enough with you when you travel.

    Side Effects

    Side effects from PPIs are rare. You may have a headache, diarrhea, constipation, nausea, or itching. Ask your provider about possible concerns with long-term use, such as infections and bone fractures.

    If you are breastfeeding or pregnant, talk to your health care provider before taking these medicines.

    Tell your doctor if you are also taking other medicines. PPIs may change the way certain drugs work, including some anti-seizure medicines and blood thinners.

    When to Call the Doctor

    Call your provider if:

    You are having side effects from these medicines

    You are having other unusual symptoms

    Your symptoms are not improving

    Note: Khan sehat ltd take information’s about the drugs from the specialists which they have in product management.