When nausea, vomiting, or slow digestion won’t quit, doctors often reach for Reglan - the brand name for metoclopramide. It’s been around since the 1970s, works fast, and helps millions. But it’s not without risks. Long-term use can cause serious movement disorders, and many people find relief without it. If you’re wondering whether there’s a safer, just-as-effective option, you’re not alone.
How Reglan Actually Works
Reglan boosts stomach emptying by increasing muscle contractions in the upper digestive tract. It also blocks dopamine receptors in the brain’s vomiting center, which cuts nausea. That dual action makes it useful for gastroparesis, chemotherapy-induced nausea, and even severe heartburn. But here’s the catch: dopamine blockade doesn’t just stop nausea. It can also trigger side effects like restlessness, drowsiness, and, in rare cases, tardive dyskinesia - a movement disorder that may be permanent.
The FDA warns against using Reglan for more than 12 weeks. Most patients take it for just a few days. But if you’re stuck with chronic nausea and need ongoing relief, Reglan isn’t the only path. Let’s look at what else works.
Domperidone: The Closest Alternative
Domperidone is the most direct substitute for Reglan. It works the same way - boosts stomach motility and blocks nausea signals - but it doesn’t cross the blood-brain barrier as easily. That means less risk of movement disorders and drowsiness. In Australia, where it’s available over the counter under brands like Motilium, it’s become the go-to for many patients.
Here’s the problem: domperidone isn’t FDA-approved in the U.S. It’s not illegal to import it for personal use, but you’ll need a doctor’s note and must order it from overseas pharmacies. Many Australians and Canadians use it legally. Studies show it’s just as effective as metoclopramide for gastroparesis and nausea, with fewer neurological side effects.
Side effects? Possible dry mouth, headaches, or mild abdominal cramps. But no tardive dyskinesia. If you’re looking for a Reglan alternative that’s nearly identical in action but safer, domperidone is the top contender.
Ondansetron: For Severe Nausea, Not Slow Digestion
If your main issue is vomiting - especially from chemo, surgery, or stomach bugs - ondansetron (Zofran) is often better than Reglan. It doesn’t speed up digestion. Instead, it blocks serotonin receptors in the gut and brain that trigger nausea. That makes it ideal for acute cases, but useless if your stomach just won’t empty.
Think of it this way: Reglan fixes the engine. Ondansetron silences the alarm. If you’re throwing up because your stomach is backed up, Reglan helps. If you’re throwing up because your brain is overreacting to a virus, ondansetron wins.
It’s available as a tablet, dissolving strip, or injection. Side effects include headaches, constipation, and dizziness. It’s safe for short-term use. But don’t expect it to fix slow gastric emptying. For that, you’ll need something else.
Erythromycin: An Antibiotic That Also Speeds Up Your Stomach
Here’s a surprise: the antibiotic erythromycin can help with gastroparesis. It acts on motilin receptors in the gut, triggering contractions that push food along. It’s not a first-line treatment, but for patients who don’t respond to Reglan or domperidone, it’s a real option.
Studies show it improves gastric emptying in about 60% of gastroparesis patients. The downside? It’s not meant for long-term use. Your body gets used to it quickly, and diarrhea is common. Also, it can interfere with other meds and raise the risk of heart rhythm issues in older adults or those with existing heart conditions.
It’s usually prescribed for short bursts - say, a week or two - to reset digestion before switching to another long-term solution. Not ideal for daily use, but useful as a bridge.
Lifestyle and Natural Options: What Actually Helps
Not everyone needs a prescription. For mild nausea or occasional bloating, simple changes often work better than drugs.
- Small, frequent meals - Instead of three big meals, eat five or six smaller ones. Less food in the stomach at once means less pressure and fewer symptoms.
- Low-fat, low-fiber foods - Fats and fiber slow digestion. Stick to white rice, bananas, boiled chicken, and toast when you’re feeling off.
- Stay upright after eating - Don’t lie down for at least two hours after a meal. Gravity helps keep food moving.
- Ginger - A Cochrane review found ginger is as effective as metoclopramide for pregnancy-related nausea. Try 250 mg capsules or ginger tea three times a day.
- Acupuncture - Studies show it reduces nausea in cancer patients and pregnant women. The P6 point on the inner wrist is the most targeted.
These aren’t magic fixes. But for many people, they reduce or eliminate the need for medication. If you’re on Reglan long-term, try combining these with your treatment. You might be able to lower your dose - or stop it altogether.
When to Avoid Reglan and Its Alternatives
Some conditions make these drugs risky.
- Parkinson’s disease - Reglan and domperidone can make symptoms worse by blocking dopamine in the brain.
- GI bleeding or obstruction - If your gut is blocked or bleeding, speeding up contractions can make things worse.
- Severe heart problems - Domperidone and erythromycin can affect heart rhythm. Check with your doctor if you have a history of arrhythmia or take QT-prolonging drugs.
- Pregnancy - Reglan is Category B (generally safe), but domperidone isn’t well studied. Ginger and lifestyle changes are preferred first.
Always tell your doctor about all your meds - even herbal ones. Some interactions can be dangerous. For example, combining Reglan with antidepressants like SSRIs can raise serotonin levels too high.
Choosing the Right Option for You
There’s no one-size-fits-all. Your best choice depends on your symptoms, health history, and how long you need treatment.
| Drug | Best For | Duration of Use | Major Side Effects | Availability (Australia) |
|---|---|---|---|---|
| Reglan (Metoclopramide) | Slow digestion + nausea | Short-term (under 12 weeks) | Tardive dyskinesia, drowsiness, anxiety | Prescription only |
| Domperidone | Slow digestion + nausea | Long-term (if monitored) | Headache, dry mouth | Over-the-counter |
| Ondansetron (Zofran) | Acute vomiting (chemo, virus) | Short-term | Constipation, headache | Prescription only |
| Erythromycin | Short-term gastric emptying boost | 1-2 weeks max | Diarrhea, heart rhythm risk | Prescription only |
| Ginger | Mild nausea (pregnancy, motion sickness) | Long-term | Heartburn (rare) | Over-the-counter |
If you’re dealing with chronic nausea and slow digestion, domperidone is your safest bet - if you can get it. If you need quick relief from vomiting, ondansetron is the winner. For short-term fixes, erythromycin can help. And for mild cases, ginger and diet changes often do the job without pills.
Don’t just switch drugs blindly. Talk to your doctor about your symptoms, your goals, and your risk factors. Sometimes, the best treatment isn’t a pill at all.
Is Reglan still prescribed today?
Yes, but much less often than before. Doctors still prescribe it for short-term use - like after surgery or during chemo - because it works fast. But due to the risk of tardive dyskinesia, it’s no longer a first choice for chronic conditions like gastroparesis. Most now try domperidone or lifestyle changes first.
Can I buy domperidone in Australia without a prescription?
Yes. In Australia, domperidone (sold as Motilium) is available over the counter at pharmacies. You can buy it for nausea, bloating, or slow digestion without a script. It’s regulated differently than in the U.S., where it’s not FDA-approved. Always check the label and talk to your pharmacist if you’re on other meds.
Does ginger really work as well as Reglan for nausea?
For pregnancy-related nausea, yes. A 2015 Cochrane review of 12 studies found ginger was just as effective as metoclopramide, with fewer side effects. For chemo-induced nausea, ondansetron is stronger. But for everyday nausea - motion sickness, morning sickness, or mild indigestion - ginger is a safe, natural option that works for many people.
Why isn’t domperidone available in the U.S.?
The FDA banned domperidone in 2004 over concerns about heart rhythm problems, especially at higher doses. But many doctors and patients argue the risk is low at standard doses (10 mg three times daily). It’s still available through special import programs for patients with no other options. Some U.S. patients order it legally from Canadian or Australian pharmacies with a doctor’s note.
What should I do if Reglan made me feel restless or twitchy?
Stop taking it immediately and contact your doctor. Restlessness, jaw clenching, or uncontrollable movements could be early signs of tardive dyskinesia. These symptoms can become permanent if ignored. Your doctor may switch you to domperidone or suggest non-drug options like acupuncture or dietary changes. Never ignore movement side effects - they’re not normal.
