Barbara asked
I'm taking mosapride here in Korea and it's a total lifesaver for GERD! Will I be able to get it (or a similarly safe prokinetic) when I return to the U.S.?
Answer
Mosapride is a gastrointestinal 'prokinetic' medication that is available in many countries, but not the United States unfortunately. There are a few alternatives available, but they have a slightly different mechanism of action, so they aren't directly comparable. In addition, these alternative products require a prescription for use and are not available over the counter.
Mosapride works mainly via two mechanisms:
- 5HT4 Agonism (Serotonin receptor 4 agonist)
- 5HT3 Antagonism (Serotonin receptor 3 antagonist)
Mosapride increases gastric emptying (i.e. stomach emptying) and is thought to induce contractions of the GI tract, all of which may help to reduce nausea, reduce the symptoms of GERD (gastroesophageal reflux disease), as well as alleviate gastritis and gastroparesis.
Mosapride, may go by several different brand names (such as Gasmotin) but is only available in Asia, South East Asia, South America, and Japan.
The closest medication in terms of mechanism of action and indication available in the United States is called Reglan (metoclopramide). It too is classifed as a 'prokinetic' agent, but has some significant differences in regard to how it works.
Metoclopramide works via the following mechanisms:
- Induces release of acetylcholine
- D2 Antagonism (Dopamine receptor 2 antagonist)
- 5HT3 Antagonism (Serotonin receptor 3 antagonist)
Metoclopramine is an effective medication for reducing nausea (and vomiting), increasing gastrointestinal motility, reducing symptoms of GERD and for the treatment of gastritis.
Unlike Mosapride, metoclopramine is only available via prescription in the United States. In most cases, it is a safe an effective drug but needs to be used with caution in certain patients. It is well known to cause sedation and very rarely can cause certain movement disorders, although this is uncommon and more of a concern in those taking conflicting medications.
