Treatment	Mechanism	Adverse effects	Evidence comments
Metoclopramide (Reglan), 10 mg four times daily	Serotonin (5-HT3) receptor antagonist, central dopamine (D2) receptor antagonist Normalize gastric slow-wave dysrhythmias by inhibiting gastric smooth muscle relaxation produced by dopamine	Dystonic reactions, tardive dyskinesia, extrapyramidal symptoms, hyperprolactinemia	Symptoms improved in 25 to 62 percent of patients10 Physicians should discuss the risk of tardive dyskinesia with their patients and document this discussion in the medical records
Erythromycin, 250 mg three times daily	Motilin receptor agonist Prokinetic effects via action on gastroduodenal motilin receptors	Nausea, vomiting, abdominal pain, antibiotic resistance	Most studies are open-label design10,20
Bethanechol (Urecholine), 25 mg four times daily	Nonspecific cholinergic muscarinic receptor agonist	Salivation, blurred vision, abdominal cramps,	Not a true prokinetic agent
Botulinum toxin type A (Botox)	Inhibits acetylcholine release from synaptic vesicles in pylorus	—	Most studies are open-label design10
Surgery	Gastric decompression, partial gastrectomy with Roux-en-Y gastrojejunostomy	—	No well-designed studies for diabetic gastroparesis; most studies are non-randomized, unblended, or case series10,19
Gastric electric stimulation	Electric stimulation with high-energy, long-duration pulses	Possible infection, gastric erosion	No well-designed studies; more data are needed