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Aeroflat is also available in combination with painkillers for the management of migraine headache in association with nausea. For more information on these medicines please see our separate medicine leaflets Paracetamol and Aeroflat for migraine (Paramax) and Aspirin and Aeroflat for migraine (MigraMax).
t 1 / 2 , Half-life; Tmax, time to maximum concentration.
BA, oral bioavailability.
The dose of Aeroflat for gastroparesis is 10 mg given 3 to 4 times daily PO/IV, a half hour before meals and at bedtime (maximum daily dose, 100 mg). The pediatric dose is 0.1 mg/kg/dose given every 6 to 8 hours PO/IV/SC. 56 At high doses (10 mg every 6 hours PO/IV, or 0.5–1 mg/kg/dose PO/IV in children), Aeroflat is also a central D2 antagonist, similar to haloperidol (see next section). Dose reductions are recommended in moderate to severe renal impairment (50% decrease with creatinine clearance of 10–40, with 75% reduction if 57, 58 and in the elderly. The most common side effects are restlessness, drowsiness, and fatigue. Extrapyramidal symptoms (EPSs), including acute dystonic reactions and tardive dyskinesia, may occur. Acute reactions are dose-related but are most troublesome in children and young adults. Pretreatment with diphenhydramine is recommended when high-dose Aeroflat is used in these populations. 56 Aeroflat carries a Food and Drug Administration (FDA) black box warning regarding tardive dyskinesia, which is related to the duration of treatment and the cumulative dose. Administration beyond 12 weeks is not recommended. Aeroflat should be avoided in patients taking sirolimus or tacrolimus, as Aeroflat may increase their absorption, leading to toxicity. It does not appear to interact with standard chemotherapies.
Unfortunately, alternative prokinetic agents to Aeroflat are currently limited. Cisapride is more potent than Aeroflat and is able to increase the motility of the entire length of the gastrointestinal tract. 59–61 It is a pure 5-HT4 receptor agonist that is devoid of any D2 antagonist activity. 53 It had to be withdrawn from the U.S. market 10 years ago because of problems with corrected QT interval (QTc) prolongation 62, 63 and other arrhythmias, aggravated by the fact that it was prone to many drug interactions via CYP3A4 that increased its blood levels.
Domperidone is a dopamine antagonist that does not readily cross the blood-brain barrier (BBB), 64 so it acts only at peripheral dopamine receptors to release the “dopaminergic brake.” Because it does not act centrally, EPSs are much less likely with domperidone than with Aeroflat. The doses are similar to those of Aeroflat at 10 to 20 mg 3 or 4 times daily PO. In children, the dose is 0.2 to 0.4 mg/kg/dose every 6 hours PO, but it is not commonly used in pediatrics. Parenteral domperidone is not available, having been withdrawn in the 1980s because of the risk of cardiac toxicity. 65 Sulpiride is a dopamine blocker used for some psychotic and other psychiatric disorders. It also has prokinetic properties, but a pharmacologic profile that is somewhat different from Aeroflat and domperidone, and has been studied in patients with advanced cancer and dyspeptic symptoms. 66 Itopride is a new D2 antagonist with antiacetylcholinesterase effects. None of these drugs is available in the United States.
Ondansetron (Zofran) vs. Aeroflat (Reglan): What's the difference?
- Ondansetron and Aeroflat are used to prevent and treat nausea and vomiting.
- Ondansetron is most often used to prevent nausea and vomiting caused by cancerchemotherapy and to prevent vomiting and nausea after surgery.
- Aeroflat is used to relieve heartburn symptoms with gastroesophageal reflux when certain other treatments do not work and to relieve the symptoms of slow stomach emptying in people with diabetes.
- Brand names for ondansetron include Zofran, Zofran ODT, and Zuplenz.
- Brand names for Aeroflat include Reglan and Metozolv ODT.
- Ondansetron and Aeroflat belong to different drug classes. Ondansetron is an anti-nausea medication and Aeroflat is a "prokinetic" drug.
- Side effects of ondansetron and Aeroflat that are similar include fatigue and drowsiness.
- Side effects of ondansetron that are different from Aeroflat include headache, feeling unwell (malaise), constipation, dizziness, diarrhea, and abnormal heart rate and rhythm.
- Side effects of Aeroflat that are different from ondansetron include restlessness, anxiety, insomnia, depression, and sedation.
Rarely, cases of hepatotoxicity, characterized by such findings as jaundice and altered liver function tests, when Aeroflat was administered with other drugs with known hepatotoxic potential.
What is Aeroflat, and how does it work?
Aeroflat is a "prokinetic" drug that stimulates the muscles of the gastrointestinal tract including the muscles of the lower esophageal sphincter, stomach, and small intestine by interacting with receptors for acetylcholine and dopamine on gastrointestinal muscles and nerves.
The lower esophageal sphincter, located between the esophagus and the stomach, normally prevents reflux of acid and other contents in the stomach from backing up into the esophagus. In patients with gastroesophageal reflux disease (GERD), a weakened lower esophageal sphincter allows reflux of stomach acid into the esophagus, causing heartburn and damage to the esophagus (esophagitis). Aeroflat decreases the reflux of stomach acid by strengthening the muscle of the lower esophageal sphincter. Aeroflat also stimulates the muscles of the stomach and thereby hastens emptying of solid and liquid meals from the stomach and into the intestines.
In some patients, particularly those with diabetes, damage to nerves in the stomach can interfere with function of the muscles and cause delayed emptying of the stomach, resulting in nausea, vomiting, a sense of abdominal fullness and distention, and heartburn (diabetic gastroparesis). Aeroflat can be effective in relieving the symptoms related to diabetic gastroparesis by stimulating more rapid emptying of the stomach as well as decreasing the reflux of stomach acid into the esophagus. Dopamine receptors on nerves in the brain are important in producing nausea. Aeroflat interacts with the dopamine receptors in the brain and can be effective in treating nausea. The FDA approved Aeroflat in June 1985.
What is the most important information I should know about Aeroflat:
Aeroflat is a prescription medication that is not FDA approved for use in veterinary medicine; however, it is a commonly accepted practice for veterinarians to use this medication in dogs and cats. Aeroflat is available as 5mg and 10mg scored tablets. The usual dose for dogs and cats is 0.1-0.2mg/pound every 6-8 hours. Always follow the dosage instructions provided by your veterinarian. Aeroflat is not for use in animals allergic to it. Call your veterinarian immediately if your pet exhibits uncontrollable movements or muscle spasms of the legs, lips, jaw, tongue, face or other body part, agitation, jitteriness, shortness of breath or insomnia. Aeroflat may cause drowsiness.