Prokinetic agents in critical care

Table 1 Summary of features and actions of cisapride, erythromycin and metoclopramide

Drug	Receptor	Class	Action
Metoclopramide	Dopamine antagonist	Motility stimulant	Sensitizes gut to acetylcholine; increases lower oesophageal sphincter tone
Erythromycin	Motilin receptors on enteric nerves and smooth muscle	Macrolide antibiotic	Increased antral activity, which may migrate caudally (depending on dose) ± activation of an intrinsic cholinergic pathway
Cisapride	Activates 5-HT₄ receptors on intrinsic sensory neurons	Motility stimulant	Initiates peristaltic reflex by simultaneously activating ascending excitatory and descending inhibitory neural pathways

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