September 7, 2026

@michaelokun

What resonates with me about this excellent review of gastroparesis is how relevant it is to Parkinson’s disease and parkinsonism, where impaired gastric motility can become much more than a gastrointestinal symptom: delayed emptying can contribute to nausea, bloating and early satiety, but it can also make absorption of critical Parkinson’s medications, particularly levodopa, delayed and unpredictable. The review specifically recognizes Parkinson’s as a neurological risk factor for gastroparesis and reminds us how remarkably limited our therapeutic toolbox remains. Metoclopramide is the only FDA-approved drug for gastroparesis, yet because it blocks dopamine D2 receptors and carries a risk of parkinsonian symptoms and tardive dyskinesia, it is generally a particularly poor choice for people with Parkinson’s and other parkinsonian disorders. This is where I think we should all be making more noise: domperidone (Motilium), a peripheral dopamine antagonist commonly used in many countries, does not readily cross the blood-brain barrier and can be useful in Parkinson’s, yet it remains unavailable as a routinely FDA-approved prescription in the United States because of cardiac safety concerns. We need safer treatments, better trials and a workable regulatory pathway because for people with Parkinson’s, the stomach can determine whether the medication that works beautifully on paper actually reaches the brain when it is needed. You will find domperidone sold all over the world, and here are some of the names it goes by in different countries: Motilium, Motilium Rapid, Peridon, Peridys, Cilroton, Cinet, Costi, Domstal, Domperitop, Nauzelin, Neoperidys, Oroperidys, Permotil, Remotil, Riges, Tametil, Touristil, and Zilium. https://jamanetwork.com/journals/jama/fullarticle/2852115