Itopride hydrochloride is a prokinetic agent with antiemetic properties, widely used in the management of functional dyspepsia and other upper gastrointestinal motility disorders. It acts as a dopamine D2 receptor antagonist and an acetylcholinesterase inhibitor, enhancing gastric emptying and improving symptoms like bloating, early satiety, and epigastric discomfort. It is a first-line therapy in the Indian context for non-ulcer dyspepsia.
Adult: 50 mg (one tablet) three times daily, taken orally before meals.
Note: Tablet should be swallowed whole with a glass of water, preferably 15-30 minutes before meals. Do not crush or chew. Can be taken with or without food, but taking before meals aligns with its therapeutic goal of improving gastric emptying of the upcoming meal.
Itopride exerts its prokinetic effect through a dual mechanism. It antagonizes dopamine D2 receptors in the upper gastrointestinal tract, which inhibits the inhibitory effect of dopamine on gastric motility. Concurrently, it reversibly inhibits acetylcholinesterase, leading to an accumulation of acetylcholine at muscarinic receptors in the myenteric plexus. This enhances cholinergic neurotransmission, stimulating gastric smooth muscle contraction, accelerating gastric emptying, and improving gastroduodenal coordination.
Pregnancy: Category B: Animal studies have not shown teratogenic risk, but there are no adequate and well-controlled studies in pregnant women. Use only if clearly needed and potential benefit justifies potential risk to the fetus.
Driving: Itopride may cause dizziness or fatigue in some patients. Patients should be advised not to drive or operate machinery if they experience these effects.
| Anticholinergic drugs (e.g., Atropine, Dicyclomine) | May antagonize the prokinetic effect of Itopride. | Moderate |
| Dopamine agonists (e.g., Levodopa, Bromocriptine) | Itopride may antagonize the therapeutic effect of dopamine agonists. | Moderate |
| Antipsychotics (e.g., Haloperidol, Risperidone) | Additive dopamine D2 receptor blockade, increasing risk of extrapyramidal symptoms and hyperprolactinemia. | Major |
| Cisapride, Erythromycin, other QT-prolonging drugs | Theoretical additive risk of QT prolongation (rare with Itopride). Monitor with caution. | Moderate |
| Ketoconazole, other potent CYP3A4 inhibitors | Minimal interaction expected as Itopride is not metabolized by CYP3A4. No significant dose adjustment needed. | Minor |