Role of Levosulpiride in the Management of Functional Dyspepsia

Functional dyspepsia (FD) consist of variable combination of symptoms of gastrointestinal tract like abdominal pain, postprandial fullness, abdominal bloating, early satiety, nausea, vomiting, heartburn and acid regurgitation, without any definitive structural or biochemical cause for it. There are varieties of treatment options available for management of dyspeptic symptoms including, replacement of Non Steroidal Anti Inflammatory Drugs (NSAIDs) with COX- 2 inhibitor, empirical treatment with Proton Pump Inhibitor and treatment of H.pylori infection. Refractory dyspeptic cases, who fail to respond conventional treatment of dyspepsia can be managed with antidepressant or pro kinetic drugs. Levosulpiride is an atypical antipsychotic, acts by blocking the presynaptic D2 dopaminergic receptor in the dopaminergic pathway. It was found that levosulpiride have more efficacy in management of dyspeptic symptoms in comparison to antisecretary agents (cimetidine, ranitidine) and prokinetic agents (metaclopramide, domperidone). Levosulpiride is as effective as cisapride in management of dyspepsia, having better tolerability, and relatively milder adverse events. Levosulpiride improves the dyspeptic symptoms like pain, discomfort, fullness, bloating of abdomen, early satiety, nausea, vomiting, associated anxiety symptoms, and health related quality of life impaired by dyspeptic symptoms. Levosulpiride quicken gastric and gall bladder emptying. It also has gastro kinetic effect and improves glycemic control in diabetic gastroparesis. Galactorrhoea, somnolence, fatigue and headache are common adverse event seen with levosulpiride therapy. Majority of adverse events were occurred in first fifteen days of treatment with levosulpiride, and they improve gradually without discontinuation of treatment. Unlike cisapride, levosulpiride is devoid of serious cardiovascular adverse effect.