As of late 2025, the pharmaceutical landscape is shifting toward drugs with "dual-action" mechanisms to overcome the limitations of metoclopramide. Naronapride, a novel oral medication, has entered Phase 2b clinical trials (the MOVE-IT study). Unlike traditional agents, naronapride targets both the 5-HT4 receptor and the D2 receptor on the intestinal wall but is minimally absorbed into the bloodstream, significantly reducing the risk of central nervous system side effects like tardive dyskinesia.

Simultaneously, Tradipitant, a Neurokinin-1 (NK-1) receptor antagonist, is undergoing FDA review for its ability to target the "substance P" pathway. This represents a new class of therapy aimed specifically at the sensory symptoms of gastroparesis, such as chronic nausea and abdominal pain, rather than just the mechanical emptying. Technical specifications on the pharmacokinetics and safety profiles of these emerging biologics can be found in the Gastroparesis Treatment Market pipeline analysis. These "locally active" drugs are expected to become the new standard for patients who are refractory to or intolerant of first-line prokinetics.