Snapshot A 46-year-old woman with a past medical history of type 1 diabetes presents for recurrent nausea and vomiting after meals over the past few months. She reports that she feels full with less amounts of food, leading to a weight loss of 10 lbs. She also reports feeling dizzy when standing up quickly. Physical exam reveals epigastric tenderness. She is started on metoclopramide for suspected diabetic gastroparesis and also encouraged to avoid fatty, spicy, or acidic foods. Introduction Drugs metoclopramide Mechanism of action dopamine (D2) receptor antagonist, which increases upper gastrointestinal motility, contractility, and lower esophageal sphincter tone, causing increased gastric emptying pro-kinetic Clinical use diabetic gastroparesis post-surgical gastroparesis anti-emesis gastro-esophageal reflux disease (GERD) Adverse effects extrapyramidal symptoms tardive dyskinesia parkinsonism dystonia akathisia treat immediately with diphenhydramine and benztropine restlessness drowsiness fatigue diarrhea contraindications small bowel obstruction Parkinson disease