Effect of Itopride on Semaglutide Gastroparesis

Semaglutide delays gastric emptying and increases the risk of aspiration with anesthesia; So, the addition of prokinetics as Itopride could enhance gastric emptying and hastens surgery.

Semaglutide, a glucagon-like peptide-1 (GLP-1) agonist, is gaining popularity for the treatment of type 2 diabetes mellitus (T2DM) and obesity; Semaglutide stimulates insulin excretion and delays gastric emptying.Itopride, a novel prokinetic agent, acts as a dopamine D2 receptor antagonist and an acetylcholine esterase inhibitor. Itopride shows promise in managing gastroparesis symptoms by accelerating gastric emptying, improving gastric tension and sensitivity, and exerting antiemetic effects.

The investigator designed this prospective, randomized, double-blind controlled study to evaluate the effect of Itopride on Semaglutide induced gastroparesis and residual gastric contents after 8-hours fasting by gastric ultrasound before anesthesia.

Inclusion criteria

• American Society of Anesthesiologists grade I- III.
• Age: 40-60 years.
• BMI: 20-30 kg/m2.
• Diabetic patients on semaglutide (0.5-1mg) SC weekly.
• Undergoing elective hysterectomy.

Exclusion criteria

• Declining to give written informed consent.
• history of upper abdominal surgery or the presence of hiatal hernia.
• Other medications inducing gastroparesis (opioids, proton pump inhibitors, tricyclic antidepressants, calcium channel blockers, antipsychotic medications, and lithium).
• History of allergy to Itopride.
• History of cardiac arrhythmia or abnormal ECG.
• Neurologic diseases (including Parkinson's disease and multiple sclerosis)
• Hepatic or renal failure.