Prokinetics for SIBO

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In all my spare time I put together A Gutsy Girl’s Master Guide to Prokinetics because prokinetics for SIBO are critical.

Am I nerding out enough yet? No?

Well good because I have zero intentions of slowing down anytime soon. 🙂

Quick answer:

A prokinetic is a drug or herbal compound that stimulates GI motility, the muscle contractions that move food and waste through your gut. For SIBO, prokinetics are used between antibiotic rounds and after treatment to keep the migrating motor complex (MMC) working and prevent relapse. Options range from prescription drugs to magnesium, ginger, and Iberogast.

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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. 

Prokinetics for SIBO: 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.

A Gutsy Girl's Master Guide to Prokinetics agutsygirl.com

Pharmaceutical Grade: SIBO 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!

  1. Cisapride (Propulsid®) — withdrawn from the US market in 2000. Available only through the manufacturer’s Limited Access Program, and new enrollment has narrowed sharply.
  2. Domperidone (Motilium®) — not FDA-approved. The only legal path in is an expanded-access IND program, and its supply chain has been unstable since 2025.
  3. Metoclopromide (Reglan®, Maxeran®) — FDA-approved, available by prescription.
  4. Levosulpiride (Levobren®, Levopraid®) — available in Italy and Korea, not approved in the US.
  5. Erythromycin — used off-label at low, sub-antibiotic doses for motility.
  6. Tegaserod (Zelnorm®, Zelmac®) — reintroduced by the FDA in 2019 for women with IBS-C, then pulled from the US market again by the manufacturer in 2022. Not currently available.
  7. Mosapride Citrate (Ganaton®) — available in Asia, Southeast Asia, and Japan.
  8. Itopride hydrochloride (Ganaton®) — available in Asia, Southeast Asia, and Japan.
  9. Renzapride — completed Phase III trials in the US in 2008. Never reached market.
  10. Pruclopride (Motegrity®) — FDA-approved in December 2018 for chronic idiopathic constipation. Available by prescription in the US.
  11. LDN (Low Dose Naltrexone) — available in the US by prescription, usually through a compounding pharmacy.

Sourced individually from MedlinePlus, Mayo Clinic, Drugs.com, and current FDA and clinical trial records.

Prokinetics for SIBO agutsygirl.com

Non-Pharmaceutical Grade: SIBO Prokinetics

Below are various natural prokinetics that anyone has access to.

  1. 5HTP
  2. Ginger
  3. Triphala (I carry a similar herbal blend in Herbal Stack if you want a done-for-you option)
  4. Magnesium (also see vs. Citrate HERE)
  5. Iberogast
  6. MotilPro
  7. Bitters (I like Digestive Bitters for this)

That’s a long list.

If you don’t know where to start, start with magnesium.

For me personally, it’s the one prokinetic I still take today, and it’s the one you’ll see me recommend the most for slow motility and constipation.

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Prokinetics I Have Used

I have used (in the past, currently, or currently but only intermittently) the following prokinetics:

  1. LDN
  2. Herbal Stack
  3. ginger
  4. magnesium
  5. Iberogast
  6. MotilPro

All of the above worked; the ones I still use to this day (because I find them super effective) are: Digest Plus from the Herbal Stack, ginger, and magnesium. 

Move Now product information gutbyome.com
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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.

Prokinetics FAQ

What’s the best time to take a prokinetic?

I take mine before eating, except for LDN, which I took at night. Timing depends on the specific prokinetic and your gut, so work with your doctor or a nutritionist to dial in what’s right for you.

Can your body build a resistance to prokinetics over time?

It’s possible, especially with natural options. A few Gutsy Girls in the comments here have found that herbal prokinetics like ginger or bitters lose their punch after several weeks and need rotating. If something that used to work stops working, it’s usually a sign to rotate or adjust. Talk to your doctor about what to try next.

My LDN doesn’t seem to be helping my motility. What should I do?

Dose matters. I took 4.5 mg, which is what works for my motility. If you’re on a lower dose and not seeing results, ask your doctor whether adjusting it makes sense. LDN isn’t one-size-fits-all, and neither is the timeline for feeling it work.

How long should I try a prokinetic before switching to something else?

Give a natural prokinetic 4 to 6 weeks of consistent use before deciding it’s not working. That’s the general window I’ve seen hold up, both for me and in the comments here. If you’re still stuck after that, loop in your doctor and reassess.

If you liked this post, you might also enjoy:

  1. Quick Gut Detox
  2. DIY Lemonade for Constipation
  3. Fasting for Gut Healing

Xox,
SKH

A Gutsy Girl

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33 Comments

  3. Hello,

    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?

  4. 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!

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  7. 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.

  9. 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.

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  11. 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 ❤️

  13. I’m still not totally clear on the LDN piece… I take it there are no natural sources?

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  16. Hi Sarah,

    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!

  18. Hi which supplement from natural calm on amazon do you recommend? They have so many options. 🙂

  22. 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.

  25. 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..

  26. Hi Sarah,

    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?

    Thanks
    XO

  27. 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 🙂

  28. 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

  29. I am dependent on the Domperidone to be able to eat as well. I would love to have an alternative that worked!

  30. 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.

  32. 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!

    Thanks!

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