Promotility agents should ideally enhance esophageal peristalsis and accelerate gastric emptying, while decreasing the number and duration of transient lower esophageal sphincter relaxations. There are no medications available that specifically target transient lower esophageal sphincter relaxations, although this relaxation is recognized to be the most important pathophysiologic mechanism of reflux. To date, the effectiveness of commercially available promotility agents in children is unproven and not recommended for routine use. In addition, a number of promotility agents may have common, serious side effects such as cardiac arrhythmias and central nervous system complications. Putnam et al (1992)1 reported that parkinsonian reactions and tardive dyskinesia may occur in up to 30% of patients taking metoclopramide and may be irreversible. The FDA released a black box warning in February 2009 stating that it is not recommended for prolonged (>2 months) use except in rare cases. (Link to FDA web site) The 2009 Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of NASPGHAN and ESPGHAN recommend against routine use of any available promotility agents to treat pediatric GERD.
1Putnam PE, Orenstein SR, Wessel HB. Tardive dyskinesia associated with use of metoclopramide in a child. J Pediatr. 1992 Dec;121(6):983–985.