Cisapride for GERD - withdrawn from the markets

Cisapride increases gastric motility. It is used to treat the following conditions:

  • Nocturnal symptoms of gastroesophageal reflux disease (GERD)
  • Gastroparesis
  • Refractory constipation, and
  • Nonulcer dyspepsia

Cisapride Dose in Adults

Dose in gastroesophageal reflux disease or gastrointestinal dysmotility:

    • 5-10 mg 4 times/day at least 15 minutes prior to meals and at bedtime.
    • 20 mg per dose may be advised to some patients to obtain a satisfactory results.

Cisapride Dose in Childrens

 Cisapride dose in gastrointestinal dysmotility and gastro-esophageal reflux disease:

  • Infants, Children, and Adolescents:
    • 0.15 to 0.2 mg/kg/dose 3 to 4 times/day to a maximum dose of 10 mg/dose.

Note: Most experts recommend a maximum dose of 0.8 mg/kg/day in divided doses.

Pregnancy Risk Factor C

  • Pregnancy should be avoided and other agents should be used.

Use of cisapride during breastfeeding

  • It can be excreted in breast milk. It should not be consumed by lactating mothers.

Cisapride Dose in Kidney Disease:

The manufacturer has not recommended any dose adjustment in patients with renal disease but it should be used with caution.

Cisapride Dose in Liver Disease:

Initiate at half the usual dose in patients with a liver disease.

Common Side Effects of Cisapride

  • Central nervous system:
    • Headache
  • Dermatologic:
    • Skin rash
  • Gastrointestinal:
    • Abdominal cramps,
    • Diarrhea,
    • Dyspepsia,
    • Flatulence,
    • Nausea,
    • Xerostomia
  • Respiratory:
    • Rhinitis

Less Common Side Effects of Cisapride

  • Cardiovascular:
    • Tachycardia
  • Central nervous system:
    • Anxiety,
    • Drowsiness,
    • Extrapyramidal reaction,
    • Fatigue,
    • Insomnia,
    • Seizure
  • Hematologic & oncologic:
    • Aplastic anemia,
    • Granulocytopenia,
    • Leukopenia,
    • Pancytopenia,
    • Thrombocytopenia
  • Hepatic:
    • Increased liver enzymes
  • Infection:
    • increased incidence of viral infection
  • Respiratory:
    • Cough,
    • Sinusitis,
    • Upper respiratory tract infection

Contraindication to Cisapride include:

  • Allergy or sensitivity to cisapride, any component of the formulations
  • Hemorrhage of the gastrointestinal tract
  • Mechanical gastrointestinal obstruction
  • Perforation of the gastrointestinal tract or other dangerous situations involving GI motility stimulation are possible.
  • Cardiac arrhythmias include:
    • Tachycardia ventriculare
    • Ventricular fibrillation
    • Torsade des pointes
    • Extension of QT
  • Fatal cardiac eventsConcomitant intravenous or oral administration of these drugs with Cisapride may result in high blood levels.
    • Antibiotics such as troleandomycin, clarithromycin and erythromycin
    • Antidepressants such as Nefazodone
    • Antifungals include fluconazole and itraconazole as well as miconazole and oral ketoconazole.
    • Protease inhibitors include Indinavir and ritonavir as well as amprenavir and atazanavir.

Patients with:

  • An extended electrocardiographic QT interval greater than 450 msec
  • History of prolongation of QT
  • Family history of congenital QT syndrome with long QT known
  • Bradycardia clinically significant
  • Failure of the renal system
  • History of congestive heart failure, ischemic cardiac disease and ventricular arrhythmias
  • Hypokalemia and hypomagnesemia are two examples of uncorrected electrolyte problems.
  • Respiratory failure
  • Concomitant medications that prolong the QT interval or increase the risk for arrhythmias such as antidepressants and antipsychotics, bepridil and sparfloxacin are all known to cause QT prolongation.
  • Patients with hypokalemia and hypomagnesemia should not use it. It is also not recommended for patients who have experienced a rapid decrease in plasma potassium, such as those taking potassium-wasting diuretics or insulin.

Warnings and Precautions

The FDA announced on March 24, 2000 that the FDA had compiled 341 cases reports, including 80 deaths reports, and that the manufacturer of Cisapride would withdraw its product from the U.S. marketplace on July 14, 2000.

  • Arrhythmias:[U.S.-Bound Warning]
    • Patients who have taken cisapride with other contraindicated medications have had serious cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation. QT prolongation has also been reported.
  • Electrolyte disturbances:
    • Patients with hypokalemia and hypomagnesemia (patients who are severely dehydrated, vomiting, malnourished, or taking potassium-wasting diuretics) should not use it.

Cisapride (United States: Available via limited access/FDA investigational drug [IND] protocol only): Drug Interaction

Note: Drug Interaction Categories:

  • Risk Factor C: Monitor When Using Combination
  • Risk Factor D: Consider Treatment Modification
  • Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).

Alcohol (Ethyl). Cisapride can increase the toxic/adverse effects of Alcohol (Ethyl). Alcohol (Ethyl's sedative and psychomotor effects can be increased. Nocturnal heartburn may be worsened by Alcohol (Ethyl). Cisapride can increase the serum Alcohol (Ethyl) concentration.
Anticholinergic Agents Prokinetic may reduce the therapeutic effects of Gastrointestinal Agents.
Moderate CYP3A4 inhibitors Might decrease metabolism of CYP3A4 substrates (High Risk with Inhibitors).
Duvelisib High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Erdafitinib High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Fingolimod QTc-prolonging effects of QT-prolonging agents may be increased (highest risk). Management: If fingolimod is used in combination with QT prolonging medications, monitor for prolongation of QTc intervals and ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
Fosnetupitant High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Larotrectinib High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Levosulpiride Benzamide Derivatives can increase the toxic/adverse effects of Levosulpiride.
Netupitant High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
NIFEdipine Cisapride could increase serum concentrations of NIFEdipine. Reports of a sustained release of nifedipine.
Opioid Agonists Prokinetic may reduce the therapeutic effects of Gastrointestinal Agents.
Palbociclib High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Agents that prolong QT (Indeterminate risk - Avoid). QTc-prolonging effects of QTprolonging agents (highest risk) may be increased. When using these agents together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
QT-prolonging agents (Indeterminate risk - Caution). QTc-prolonging effects of QT-prolonging agents may be increased (highest risk). When using these agents together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.

Risk Factor D (Consider therapy modifications)

 
Amiodarone QT-prolonging miscellaneous agents (highest risk) could increase the QTcprolonging effects of Amiodarone. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Amisulpride QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Amisulpride. Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Arsenic Trioxide QT-prolonging miscellaneous agents (highest risk) could increase the QTcprolonging effects of Arsenic Trioxide. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Astemizole QT-prolonging miscellaneous agents (highest risk) could increase Astemizole's QTcprolonging effects. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Azithromycin Systemic QT-prolonging agents (Highest risk) could increase the QTc-prolonging effects of Azithromycin Systemic. Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Bedaquiline QT-prolonging miscellaneous agents (highest risk) could increase the QTcprolonging effects of Bedaquiline. Management: Look for alternatives to this drug combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Chloroquine QT-prolonging agents (highest risk) can increase the QTc-prolonging effects of Chloroquine. Management: You may consider other combinations. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
ChlorproMAZINE QT-prolonging miscellaneous agents (highest risk) can increase the QTcprolonging effects of ChlorproMAZINE. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Cimetidine Could increase serum Cisapride concentrations. Management: Look for alternatives to Cisapride. This combination should not be used. Monitor for toxic effects of Cimetidine if it is administered or increased in dose. If cimetidine has been discontinued or reduced in dosage, this will also alert you to potential side effects.
Clofazimine Clofazimine's QTc-prolonging effects may be enhanced by QT-prolonging agents (highest risk). Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the two are combined. Patients at higher risk for QTc prolongation might have additional risk factors.
CloZAPine CloZAPine's QTc-prolonging effects may be enhanced by QT-prolonging agents (highest risk). Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Dasatinib QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Dasatinib. You should consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Doxepin-Contained Products QT-prolonging agents (highest risk) can increase the QTcprolonging effects of Doxepin-Containing products. Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Dronedarone QT-prolonging miscellaneous agents (highest risk) could increase Dronedarone's QTcprolonging effects. Management: You may consider other options to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Droperidol Droperidol's QTc-prolonging effects may be enhanced by QT-prolonging agents (highest risk). Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Encorafenib QTc-prolonging agent QT-prolonging agents may have an enhanced effect (highest risk). Management: Look for alternatives to this combination. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Escitalopram QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Escitalopram. Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Flecainide QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Flecainide. Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Fluconazole Fluconazole may have a greater QTcprolonging ability than QT-prolonging miscellaneous agents (highest risk). Fluconazole could increase the QTc-prolonging effects of QTprolonging miscellaneous agents (Highest risk). Management: You should consider alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Gadobenate Dieglumine QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Gadobenate Dimeglumine. Management: You may consider other combinations. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Gemifloxacin QTc-prolonging effects of QT-prolonging miscellaneous agents (highest risk) may be enhanced. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Gilteritinib QTc-prolonging agent QT-prolonging agents may have an enhanced effect (highest risk). Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or arrhythmias if you are using this combination.
Grapefruit Juice Increase in serum Cisapride concentration. Cisapride Therapy: Avoid grapefruit/grapefruit juice. If grapefruit/grapefruit juice has been added to/increased in your diet, be sure to monitor for toxic effects such as QT interval prolongation and ventricular arrhythmia.
Halofantrine QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Halofantrine. Management: You may consider other combinations. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Haloperidol QT-prolonging miscellaneous agents (highest risk) could increase the QTcprolonging effects of Haloperidol. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Inotuzumab Ozogamicin QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Inotuzumab Ozogamicin. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Systemic Levofloxacin-Containing Product QTc-prolonging effects of QTprolonging miscellaneous agents (highest risk) may be enhanced. Management: You may consider alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Lofexidine QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Lofexidine. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Methadone QTc-prolonging effects of QT-prolonging miscellaneous agents (highest risk) may be enhanced. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Midostaurin QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Midostaurin. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
MiFEPRIStone High risk of Inhibitors causing an increase in serum concentrations of CYP3A4 substrates. Management: Reduce CYP3A4 Substrates and monitor for elevated concentrations/toxicity during and after treatment with mifepristone. Avoid dihydroergotamine and ergotamine.
OLANZapine QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of OLANZapine. Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Ondansetron QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Ondansetron. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Osimertinib Osimertinib's QTc-prolonging effects may be enhanced by QT-prolonging agents (highest risk). Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Pentamidine (Systemic). QT-prolonging agents (Highest risk) could increase the QTc-prolonging effects of Pentamidine Systemic. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Pilsicainide QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Pilsicainide. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Propafenone Might increase the QTc prolonging effect QT-prolonging miscellaneous agents (highest risk). Management: You may consider alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
QT-prolonging Class IA (Highest risk) QTc-prolonging effects of QT-prolonging miscellaneous agents (highest risk) may be enhanced. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
QT-prolonging Class 3 Antiarrhythmics (Highest risk) QTc-prolonging effects of QT-prolonging miscellaneous agents (highest risk) may be enhanced. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors. Dronedarone is an exception.
QT-prolonging Kinase inhibitors (Highest risk) QTc-prolonging effects of QTprolonging miscellaneous agents (highest risk) may be enhanced. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
QT-prolonging miscellaneous agents (Highest risk) Cisapride may increase the QTc-prolonging effects. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors. Bepridil; Astemizole, Arsenic Trioxide; Bedaquiline; Bepridil. ChlorproMAZINE.
Moderate Risk QT-prolonging CYP3A4 Inhibitors QTc-prolonging effects of QT-prolonging miscellaneous agents (highest risk) may be enhanced. QT-prolonging Moderate CYP3A4 Drug Inhibitors (Moderate risk) can increase serum levels of QT prolonging Miscellaneous agents (Highest risk). Management: You may consider alternatives to this drug combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients with additional risk factors may be at greater risk. Fluconazole, Nilotinib and Ribociclib are exceptions.
RisperiDONE QT-prolonging agents (Highest risk) could increase RisperiDONE's CNS depressant effects. QT-prolonging agents (Highest risk) could increase the QTc prolonging effect RisperiDONE. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Sincalide Sincalide may be less effective if drugs that affect gallbladder function are taken. Management: Before Sincalide is used to stimulate the gallbladder, discontinue any drugs that affect gallbladder motility.
Sodium Stibogluconate QT-prolonging agents (highest risk) can increase the QTc-prolonging effects of Sodium Stibogluconate. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the combination is used. Patients at higher risk for QTc prolongation might have additional risk factors.
Stiripentol High risk of Inhibitors causing an increase in serum concentrations of CYP3A4 substrates. Management: Avoid stiripentol use with CYP3A4 Substrates that have a narrow therapeutic Index. This is to avoid adverse effects and toxicities. Monitoring of any CYP3A4 substrate that is used with stiripentol should be closely done.
Vemurafenib QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Vemurafenib. You should consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.

Risk Factor X (Avoid Combination)

 
Amitriptyline May increase the arrhythmogenic effects of Cisapride.
Antihepaciviral combination products May increase serum Cisapride concentrations.
Aprepitant May increase serum Cisapride concentrations.
Bepridil Cisapride could increase the QTc-prolonging effects of Bepridil.
Bicalutamide May increase serum Cisapride concentrations.
Citalopram QT-prolonging agents (highest risk) can increase the QTc-prolonging effects of Citalopram.
Clarithromycin Clarithromycin may have a QTc-prolonging agent (highest risk) that can increase its QTc-prolonging effects.
Cobicistat May increase serum Cisapride concentrations.
Conivaptan High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Domperidone QTc-prolonging Agents (Highest risk) could increase the QTc-prolonging effects of Domperidone.
Flupentixol Flupentixol may have a QTc-prolonging agent (highest risk) that can increase its QTc-prolonging effects.
Fosaprepitant Increases serum Cisapride concentration. This effect is likely to be due to the active metabolite, aprepitant.
Fusidic Acid (Systemic). High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Idelalisib High risk of Inhibitors causing an increase in serum CYP3A4 Substrates concentrations
Itraconazole May increase serum Cisapride.
Ketoconazole Systemic May increase serum Cisapride concentrations.
Loprazolam Loprazolam may have a higher therapeutic effect if Cisapride is added.
Moxifloxacin Systemic QT-prolonging agents (Highest risk) can increase the QTc-prolonging effects of Moxifloxacin Systemic.
Nefazodone May increase serum Cisapride concentrations.
Nilotinib QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Nilotinib.
Pimozide QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Pimozide. Management: You may consider other combinations. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia.
Piperaquine Piperaquine may have a QTc-prolonging agent (highest risk) that can increase its QTc-prolonging effects.
Posaconazole May increase serum Cisapride concentrations.
Probucol Probucol may have a QTc-prolonging agent (highest risk) that can increase its QTc-prolonging effects.
Protease inhibitors This may increase the serum level of Cisapride. This could cause QTc prolongation or malignant cardiac arrhythmias. Management: The drug interactions monographs for drugs listed as an exception to this monograph will be discussed in greater detail. Saquinavir are exceptions.
Protriptyline May increase the arrhythmogenic effects of Cisapride.
QT-prolonging Strong CYP3A4 Antiinhibitors (Moderate risk) May increase the QTc-prolonging effects of Cisapride. The serum Cisapride concentration may be increased by QT-prolonging Strong CYP3A4 inhibitors (Moderate risk).
QUEtiapine QT-prolonging agents (highest risk) can increase the QTc-prolonging effects of QUEtiapine.
Ribociclib QT-prolonging agents (highest risk) could increase Ribociclib's QTc-prolonging effects.
Roxithromycin May increase the QTc-prolonging effects of Cisapride. Roxithromycin could increase Cisapride's serum concentration.
Simeprevir May increase serum Cisapride concentrations.
Sparfloxacin QT-prolonging agents (highest risk) could increase the QTc-prolonging effects of Sparfloxacin.
Telithromycin May increase serum Cisapride concentrations.
Thioridazine QT-prolonging agents (highest risk) can increase the QTc-prolonging effects of Thioridazine.

Monitoring Parameters:

  • Prior to initiating therapy with cisapride, a 12-lead ECG should be performed.
  • If the QT interval is more than 450 ms, treatment with cisapride should not be initiated.
  • Serum electrolytes (potassium, calcium, and magnesium) and creatinine should also be assessed prior to administration of cisapride and periodically as indicated.

How to take Cisapride?

Administer orally 15 minutes or more prior to the meal. 

Mechanism of action of Cisapride:

  • Increases the release of Acetylcholine from the Myenteric Plexus of the intestine.
  • Studies in vitro have shown that cisapride has serotonin-4 receptor antagonistic properties. This could be:
  • Increase gastrointestinal motility, and increase cardiac rate
  • It increases the esophageal pressure and esophageal peristalsis.
  • Gastric emptying of liquids and solids is accelerated.

TheStart of actionIt takes half an hour. 

It is 97-98%Protein boundIt is

The liver metabolizesTo use cytochrome P450, isoenzyme CYP3A3/4nor-cisapride

Bioavailability is a measure of the bioavailability and effectiveness of cisapride

It is found in a range of 35% to 40%, with a half-life of 6-12 hours. 

It is excreted in urine, but less in feces.

International Brands of Cisapride:

  • Acpulsif
  • Alimix
  • Cisamod
  • Cisaride
  • Gasprid
  • Gastromet
  • Ondax
  • Prepulsid
  • Pridesia
  • Stimulit
  • Unamol

Cisapride Brands in Pakistan:

No brands available in Pakistan 

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