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

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