In all my spare time I put together A Gutsy Girl’s Master Guide to Prokinetics. Am I nerding out enough yet? No? Well good because I have zero intentions of slowing down anytime soon.
What is a Prokinetic?
A prokinetic, simply put, is something that stimulates movement or gastrointestinal motility.
They are drugs or herbal compounds that cause strong contractions and emptying of either the stomach contents or the small intestine.
At the 2017 SIBO conference it was stated that, “Prokinetics are used between treatment rounds and after eradication to prevent relapse by stimulating the MMC.” They help prolong remission time.
Why do many Gutsy girls need prokinetics?
Gut motility is the term given to the stretching and contractions of the muscles in the gastrointestinal (GI) tract. The synchronized contraction of these muscles is called peristalsis. These movements enable food to progress along the digestive tract while, at the same time, ensuring the absorption of the important nutrients. Learn all about it HERE.
According to Dr. Hagmeyer,
People who have IBS-C or IBS-M or people who have had a positive Methane Breath Test usually have problems with the MMC- If your body is unable to move food, waste and bacteria down and out, and on top of it there is an issue with the ileocecal valve, then bacteria, parasites and co-infections can easily overgrow into the small bowel. Any time the MMC slow down or becomes dysregulated, you are slowing down the sweeping, cleansing actions which are so integral to GI health and immune health.
By the way, MMC stands for migrating motor complex and you can learn more about it in my post on Intermittent Fasting for SIBO. I also mention the IC Valve HERE.
A Gutsy Girl’s Master Guide to Prokinetics
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As stated above, there are both drug and herbal compounds that make up various prokinetics.
Make note that you cannot get all of these. Some are prohibited, others available only in other countries, and some are still being tested.
This is just a list of all pharmaceutical grade prokinetics that have been (or are currently being) researched.
Most people have no idea that motility is even a problem, much less that there are this many prokinetic agents out there. Fascinating!
- Cisapride (still available under compassionate-release programs)
- Domperidone (Motilium®)
- Metoclopromide (Reglan®, Maxeran®)
- Levosulpiride (Levobren®, Levopraid®, available in Italy/Korea)
- Erythromycin (low dosages, not antibiotic dosing levels)
- Tegaserod (Zelnorm®, Zelmac®, now only available under special FDA protocols)
- Mosapride Citrate (Gasmotin®, available in Asia, SE Asia, South America, and Japan)
- Itopride hydrochloride (Ganaton®, available in Asia, SE Asia, and Japan)
- Renzapride (2008, a Phase III trial in USA has been completed)
- Pruclopride (Resolor®, available in the UK and EU countries)
- LDN (Low Dose Naltrexone)
Below are various natural prokinetics that anyone has access to.
- Magnesium (I also love Natural Calm)
- Dr. J’s Herbal Bitters formula:
- Oregon grape/Gentian/Baical Skullcap/Dandelion root: 2-3 whole droppers in water 15 min before meal
Prokinetics I Have Used
I have used (in the past, currently, or currently but only intermittently) the following prokinetics:
All of the above worked; the ones I still use to this day (because I find them super effective) are: LDN, ginger, and magnesium.
I believe that focusing on the MMC is key in overcoming SIBO. If you haven’t yet spent time focusing on it and are still feeling miserable, consider it today.
If you liked this post, you might also enjoy:
- The FREE 21-Day Gut Healing Inspiration Journey HERE.
- DIY Lemonade for Constipation
- Fasting for Gut Healing
You will heal. I will help.
So which prokinetic has worked for you
It’s in the post 🙂
Hi! I actually don’t see this answer in the post. You have a list of prokinetics you’ve *used*, but you don’t say specifically anywhere what *worked* for you, or how well any of them worked or didn’t work.
Hi! This post was more a master guide to them – not what worked and didn’t for me. That said, hands down, LDN 🙂
Can you tell me what doses and brands you use today? I tried motilpro, motrgreity and Linzess after sibo treatment none work for conspiation… I’m so so uncomfortable
Hi Sarah, What dose LDN do you find is effective for motility? I’ve bee taking LDN (3mg) for quite awhile but it’s had zero impact on the ol’ bowels!
Hi, I take 4.5mg so possibly ask your doctor about that.
Thanks for the info! So you take magnesium citrate before each meal?
Can people become resistant to prokinetics? For example, if I use Motilpro for 6 months, should I change to another prokinetics? If I use Ginger root instead Motilpro, can I still be resistant to prokinetics?
I have been reading your blogs like it is my job! I just got my results and I do have SIBO (it wasn’t a shock as I had all the symptoms), but for the Prokinetics, did you take them after your antibiotic protocol or during? Thank you so much for your help and guidance!
Hi! I’m so happy to e-meet you, Sara! During and after…..:)
I have a short segment of paralysis at my ileum, dysmotility, malabsorption and SIBO all caused by massive abdominal adhesions. I noticed Artichoke Leaf Extract isn’t on your list and its very effective at 600mg in conjunction with ginger at 1000mg before meals. However its been my experience and now also confirmed by an ND at Bastyr University, that natural prokinetics can lose their effectiveness after 6 weeks. So I’m switching to Iberogast and lemon water for the next 6 weeks. I’m relaying this info in case it can help anyone else with extreme pain caused by SIBO, gut fermentation and the like.
Hi there. Thank you so much for this post! I was wondering when the best time to take the pro kinetics would be? I would be starting with magnesium, triphala, and/or ginger because that’s what I have at home. Do we take/drink before, after or even hours after a meal to ensure digestion happens first then stomach emptying?
How many times a day?
I scored a 42 on the methane portion of my test and tomorrow is my last day of antibiotics. Looking forward to figuring out the best course of action in order to ensure eradication long term.
Thank you in advance ❤️
Hi! I take mine before eating (except not the LDN), but you should definitely check with your doctor or nutritionist for whichever prokinetic you choose to take.
I’m still not totally clear on the LDN piece… I take it there are no natural sources?
Hi! No natural sources of???
I know it’s not in your post but, since this post, have you tried Triphala and did you find it effective? I saw you mention it but, didn’t see that you actually used it. Thank you!
Hi Eric – No, I have not tried it.
Hi which supplement from natural calm on amazon do you recommend? They have so many options. 🙂
I like the plain one.
How much ginger is taken?
Everyone will be different.
Thank you for doing an article on this. I found information last Spring on motility and it hasbeen a game changer. I just take one capsule of ginger with dinner and 400 mg of magnesium at bedtime. I have not had a SIBO flare in over a year. It has been wonderful! I would also recommend keeping track of what foods trigger you. Even all cleaned up and everything moving, alcohol effects me. I only drank a few times a year, but those real sugary drinks just don’t sit well with my gut.
Thanks for sharing, Christy!
Hi, Sarah, Im coming to this from a different angle. I have Gastroparesis, and I usually take Domiperidone to activate the muscles and allow me to eat, but with the Covid 19 stopping much international shipping, i am running out of domiperidone and the supplier i use isnt taking orders currently. What would be the most effective non pharmaceutical prokinetic i can use? Without the domiperidone i basically cant eat..
I am dependent on the Domperidone to be able to eat as well. I would love to have an alternative that worked!
I live in the USA. is there a way for me to get Dom peridone shipped to me internationally? Please let me know. As I am taking Reglan right now and my body is getting acclimated to it.
I live in the USA. how can I get domperidone delivered to me where can I get it?
Not sure why my last comment went under my full name “Anna and then my last name” but would you mind not posting that one publicly please?
No worries! I deleted it and here was your original question: Hi Sarah,
Can I alternate natural prokinetics nightly? Or should I stick to one?
For example, magnesium one night, triphala the next, etc?
That said, I would work with your doctor on the best prokinetic protocol for you 🙂