If you’ve been diagnosed and treated for SIBO, a prokinetic may be helpful for you to maintain your results and keep symptoms from creeping back. Prokinetics work by supporting the gut’s migrating motor complex, the “housekeeping” waves that clear the small intestine between meals so bacteria are less likely to overgrow again.

In this guide, we’ll cover what SIBO is, what prokinetics do, the best natural and pharmaceutical options typical doses, and side-effects, plus how to use them safely as part of a relapse-prevention plan.

What is SIBO?

Small Intestinal Bacterial Overgrowth means there are too many microbes in the small intestine, where numbers should normally stay relatively low. When bacteria (and in some cases methane-producing archaea) proliferate higher up the gut, they ferment carbohydrates prematurely, producing gas wind and bloating that irritate the lining and disrupt motility, absorption, and can be linked to diarrhoea or constipation.

Common symptoms of SIBO include

• Bloating and visible distension (often worse after meals)
• Excess gas, belching, or flatulence
• Abdominal discomfort or cramping
• Altered bowels: diarrhoea, constipation, or a mix
• Reflux/heartburn, nausea, early fullness
• Food intolerances (especially to fermentable carbs)
• Fatigue or “brain fog”, and in long-standing cases, signs of malabsorption (e.g., B12 or iron deficiency)
  

What is a Prokinetic?

A prokinetic is a medicine or natural agent that improves the movement (motility) of your digestive tract especially the migrating motor complex (MMC), the “housekeeping” waves that sweep residual food and bacteria out of the small intestine between meals.

 In SIBO treatment protocols prokinetics are usually added after antimicrobial treatment to help maintain results and lower the risk of relapse.

How do  prokinetics help SIBO ?

A prokinetic will strengthen and stimulate upper gut motility/ gut contractions so contents move along at the right pace.

• Specifically they will  stimulate the migrating motor complex so that bacteria and microbes are flushed out of the small intestine.
  
• The MMC is a cleansing wave that only works when you are  fasting periods (e.g., overnight and in the gaps between meals).
  
• Prokinetics reduce stagnation, making it harder for microbes to linger and overgrow again.
  
  
  

Are prokinetics laxatives?

No, prokinetics are not to be mistaken for laxatives: laxatives draw water into the bowel or stimulate the colon; they don’t reliably support the MMC in the small intestine. They stimulate upper gut motility not lower gut as laxatives do.

Prokinetics are not antispasmodics: antispasmodics calm cramping by relaxing muscle; prokinetics do the opposite—they encourage coordinated movement.

Types of prokinetics

These are some of the Pharmaceutical medications that are used for SIBO.

• Motilin agonists (e.g., low-dose erythromycin/azithromycin): these medications mimic the gut hormone motilin to trigger MMC-like activity—often used short term at low doses, commonly at bedtime.
  
  
• 5-HT4 (serotonin) agonists (e.g., prucalopride): These enhance peristalsis and transit; licensed in the UK for chronic constipation and widely used off-label to support motility after SIBO treatment.
  
  
• Dopamine antagonists (e.g., domperidone, metoclopramide): These increase upper-GI tone and emptying; generally short-course only due to safety limits.
  
  
• Cholinesterase inhibitors (e.g., pyridostigmine): boost acetylcholine signalling; reserved for specialist dysmotility cases.
  
  

Natural Prokinetics

Natural prokinetics you can get in the UK (no prescription):

When you’ve finished antimicrobial treatment for SIBO, a gentle, prokinetic can help you maintain results.

Below are UK-available, over-the-counter options.

1) Ginger (capsules, tablets, or tea)

This in my opion is the best natural prokinetic for SIBO. Ginger supports upper-gut motility by strengthening antral contractions and helping food move out of the stomach at a steadier pace. This is what I frequently use in my clinic.

Ginger does

• In clinic I use between 500–1,000 mg once or twice daily between meals (or ~20–30 min before a main meal).I also recommedn Ginger Tea/infusion: 1–2 cups daily, sipped between 90 minutes after meals
• Ginger can help with early post-meal bloating, feeling of fullness and , nausea.
• Sometimes Ginger can aggravate heartburn or reflux in some patients.
  
  

2) Ginger + Artichoke leaf (standardised combo)

Artichoke leaf supports bile flow and fundic (stomach) function; ginger helps the MMC.

• Typically 1 capsule before lunch and/or dinner.
• Again this may help fullness after eating, slow meal progression, post-prandial bloating.

3) Traditional bitters (gentian, dandelion, artichoke, orange peel)

Bitters stimulate vagal/enteric reflexes that boost secretions and will help with appetite and digestion

• Take 10–20 drops (or as per label) in a splash of water 10–15 minutes before meals.
• They are helpful for sluggish appetite, belching.
  

4) Multi-herb motility formulas (e.g., Iberogast®/STW-5)

These blends can modulate tone along the upper gut and small intestine. Many people find them helpful when symptoms are mixed (bloating + nausea + variable stools). However they need to be used under medical supervision.

• How to use: as per product label (drops in water, usually up to 3× daily).
• NB: rare liver-related side effects have been reported; avoid if you have liver disease, and stop immediately if you notice jaundice, dark urine, or right-upper-abdominal pain.
  
  

5) Magnesium laxative (not a prokinetic—but helpful for lower gut motility and constipation )

Magnesium (citrate, oxide, glycinate blends) isn’t a true prokinetic; it’s an osmotic laxativr that draws water into the bowel, softening stool. That said, normalising stool form can reduce back-pressure and support overall rhythm—useful if constipation is part of your picture.

• How to use: start low (e.g., 200g in the evening) and titrate every few days to comfortable, formed stools.
• Best for: constipation-predominant patterns or methane/IMO tendencies.
• Watch-outs: too much → loose stools; adjust slowly if you have kidney disease
  
  

6) Fibre that plays nice (PHGG, psyllium—titrated)

Again, these are not prokinetics, but partially hydrolysed guar gum (PHGG) or finely ground psyllium can improve stool form and encourage a more regular colonic rhythm if you have constipation.

• How to use: begin with ½ teaspoon daily, increase by ½ tsp every 3–4 days to tolerance (common range 1–2 tsp daily).
• Best for: gentle, sustainable bowel regularity without gas spikes (PHGG is usually the easiest on a sensitive gut).
• Watch-outs: go slow—adding too much, too quickly can rekindle bloating.

How else can I stimulate the Migrating Motor Complex?

The MMC only functions when you’re fasting, so it is best to eat three meals (or two meals and one planned snack) with 3–5 hours between them, and aim for a ~12-hour overnight fast.

Anything you eat with calories breaks an MMC window (yes, milky coffees, juices, kombucha, collagen gummies), so keep those with meals; between meals stick to water, herbal tea, or black coffee if tolerated. Absolutely no snacking or grazing is allowed!

When are prokinetics used in a SIBO plan?

In my clinic, we typically use prokinetics after you’ve finished antimicrobial therapy (antibiotics or herbal protocol) to help keep SIBO from returning.

Key takeaway: A prokinetic doesn’t “kill bacteria”—it restores flow. Paired with smart meal timing and addressing root causes (e.g., thyroid, adhesions, constipation), it’s often the missing maintenance step that helps your SIBO results last.

Tip: If you have constipation with gas and “slow transit” features often points to intestinal methanogen overgrowth (IMO) — methane is produced by archaea, not bacteria, but it presents similarly and is managed alongside SIBO

Why does SIBO happen?

Several factors can make the small bowel a friendlier place for microbes to linger and multiply:

• Motility impairment — especially a weakened migrating motor complex (MMC), the fasting “housekeeping” waves that sweep the small bowel between meals. This may be disrupted after surgery.
• Structural issues — adhesions after surgery, strictures, diverticula, blind loops
• Nerve or muscle problems — diabetes-related neuropathy, connective-tissue disorders (e.g., EDS), autonomic dysfunction
• Medication effects — opioids, some anticholinergics; long-term acid suppression may play a role for select patients
• Post-infectious changes — after food poisoning or gastroenteritis, the MMC can be disrupted
• Other drivers — hypothyroidism, low stomach acid or pancreatic output, and inflammatory conditions
  
  

How is SIBO diagnosed?

In practice, most clinics use SIBO breath testing:

• Glucose or lactulose test substrates are fermented by microbes to hydrogen (H₂) and/or methane (CH₄); rises on serial breath samples suggest overgrowth.
• Patterns can help differentiate hydrogen-predominant SIBO (often looser stools) from methane-predominant/IMO (often constipated).
• Breath testing isn’t perfect (false positives/negatives can occur), so clinicians read results in context with symptoms, history, and response to treatment.
• Hydrogen sulfide (H₂S) testing exists in some labs but isn’t yet widely available in the UK.

Why does SIBO come back?

Three big reasons:

1. Motility hasn’t been restored — if the MMC remains sluggish or constantly interrupted by grazing, microbes can re-accumulate.
2. Root causes persist — adhesions, strictures, or nerve issues continue to seed relapse.
3. Aftercare gaps — antimicrobials reduce the load, but without a maintenance plan (meal spacing, gentle movement, and often a prokinetic), benefits can fade.
   
   

Key Tkeaway

SIBO is as much a motility problem as it is a microbial one. That’s why—after you’ve treated the overgrowth—supporting the MMC with the right prokinetic and simple lifestyle habits is often the key to keeping results.

After antimicrobial therapy, the most reliable way to protect your gains is to support the migrating motor complex (MMC) with 3–5 hour gap in between meal , ~12-hour overnight fast) and, where appropriate, a well-chosen prokinetic.

If you’re ready to build a personalised maintenance plan, we can help.

Book a consultation at our IBS & SIBO clinic to review your breath test, symptoms, supplements, and nutrition, and to design a step-by-step MMC strategy—from meal structure and natural supports to prescription options when needed—so your results last.

FAQs

Prokinetics & SIBO

Do I need a prokinetic after antibiotics or herbal antimicrobials?
Often, yes. A short maintenance phase supports the migrating motor complex (MMC) and reduces the chance of relapse when paired with meal spacing and an overnight fast.

How long should I take a prokinetic?
Typically 4–8 weeks, then review. Some people de-escalate to the lowest effective dose or alternate-day use; long, continuous macrolide use isn’t recommended.

Are prokinetics the same as laxatives?
No. Laxatives act mainly on the colon; prokinetics stimulate upper-gut/small-bowel movement and MMC activity.

Will a prokinetic cure SIBO without antimicrobials?
No. Prokinetics support flow; they don’t eradicate overgrowth. They work after antimicrobial therapy to help maintain results.

What’s the best natural prokinetic?
Ginger has the strongest human data for improving gastric emptying and antral contractions. Typical use: 500–1,000 mg 20–30 minutes before a main meal or between meals; or 1–2 cups of ginger tea between meals.

Is ginger safe for everyone?
Usually well tolerated, but it can aggravate reflux and may interact with anticoagulants. Avoid high doses in pregnancy unless advised by your clinician.

What about ginger + artichoke?
Useful for fullness and slow-feeling digestion before lunch/dinner. Avoid if you have gallstones or biliary obstruction.

Do bitters help motility?
They can “prime” digestion when taken 10–15 minutes before meals, but may worsen reflux/gastritis. Not advised in pregnancy unless cleared.

Are domperidone or metoclopramide good long-term options?
No. In the UK, domperidone is restricted (cardiac/QT risk) and metoclopramide is short-course only (neurological risk). They’re not maintenance choices.

Is azithromycin a prokinetic or an antibiotic?
Both. It’s an antibiotic that also stimulates motilin receptors at low dose. If used off-label as a prokinetic, keep dose low, duration short, and screen QT/interaction risks.

How do I avoid erythromycin “wearing off”?
Use low dose at bedtime (e.g., 50 mg) for a time-limited window, align with an overnight fast, and take breaks rather than continuous use.

What breaks an MMC fasting window?
Any calories: milky coffee, juices, kombucha, bone broth, collagen gummies, alcohol. Between meals stick to water, herbal tea, or black coffee if tolerated.

Can I drink coffee between meals?
Black coffee usually doesn’t break the MMC in most people; add milk and it does. If coffee worsens reflux or motility, switch to herbal tea.

How do I know if my prokinetic is working?
Bloating occurs later and less intensely, stools trend to Bristol 3–4, and evening distension reduces. Track timing and stool form for 2–4 weeks.

Can children or teens use prokinetics?
This requires paediatric specialist input. Do not start without prescriber guidance.

Do probiotics act like prokinetics?
No. Some probiotics may influence motility indirectly, but they don’t replace a prokinetic or MMC-friendly timing.

Do I still need a prokinetic if my breath test is negative but I bloat?
Sometimes. If symptoms suggest upper-gut slowness, a short prokinetic trial and strict meal spacing can still be reasonable—discuss with your clinician.Are prokinetics the same as laxatives?

Do prokinetics have side-effects?

Yes, side-effects are very common see below for more details”

Prescription prokinetics

• Macrolides (erythromycin, azithromycin) – can cause nausea, cramping, loose stools; Use low dose, short term; avoid if you have significant cardiac risk or take other QT-prolonging drugs.
  
• 5-HT4 agonist (prucalopride) – headache, nausea, diarrhoea, dizziness (often settle in 1–2 weeks). Rare reports of mood changes; dose adjust in renal impairment.
  
• Dopamine antagonists (domperidone, metoclopramide) – domperidone has cardiac/QT risk (keep dose low, duration short); metoclopramide can cause extrapyramidal symptoms/tardive dyskinesia
  

Non-prescription “natural” Prokinetic side-effects

• Ginger – reflux or heartburn in some; may potentiate anticoagulants.
• Ginger + artichoke – similar to above; avoid with gallstones/biliary obstruction.
• Bitters – can aggravate reflux/gastritis; avoid in pregnancy unless cleared.
• STW-5/Iberogast® – generally well tolerated but rare liver injury reported; avoid with liver disease and stop if you notice jaundice or dark urine.
• Magnesium (not a true prokinetic) – too much causes loose stools; use caution with kidney disease.

What is the best natural prokinetic?

Human trials show ginger can speed gastric emptying and strengthen antral contractions, which is exactly the kind of upper-gut “nudge” you want post-SIBO. Practical use: 500–1,000 mg capsule 20–30 minutes before a main meal (or between meals), once or twice daily; or 1–2 cups of ginger tea between meals. Watch for reflux (it can aggravate heartburn in some) and be cautious with anticoagulants.

Do I need a prokinetic agent forever?

Usually not. Many patients use them short–medium term while MMC-friendly habits take hold.

Is ginger “enough”?

For upper-gut heaviness/early bloat, ginger (± artichoke) often helps; Studies indicate ginger does help with gastric emptying/antral contractions. If constipation is also an issue you may also need laxatives

About the Author

Victoria Tyler a UK registered Nutritional Therapist and member of the British Association of Nutritional therapy. She was awarded UK BSc Honours Degree in Nutritional Therapy and has trained in GI Functional Medicine. Victoria has been working with Gut disorders since 2004 after first experiencing digestive problems herself.

She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before offering a bespoke IBS service.

If you need help with digestive symptoms please contact us and we would be pleased to book you in for a consultation at our IBS clinic






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