Cisapride

Indications

Cisapride is used for: Gastrointestinal Dysmotility

Adult Dose

Gastrointestinal Dysmotility 5-10 mg PO q6hr May need to increase to 20 mg in some patients

Child Dose

Gastrointestinal Dysmotility 0.15-0.3 mg/kg/dose PO q6-8hr; not to exceed 10 mg/dose

Renal Dose

Administration

Contra Indications

Hypersensitivity Serious cardiac arrhythmias (eg, ventricular fibrillation, torsades de pointes, and QT prolongation) reported in patients taking cisapride with other drugs that inhibit cytochrome CYP3A4 or have additive QT prolonging effect; some of these events have been fatal Patient history or family history of prolonged QT syndrome History of renal failure, ventricular arrhythmias, ischemic heart disease, CHF, clinically significant bradycardia, uncorrected electrolyte disorders (eg, hypomagnesemia, hypokalemia), and respiratory failure

Precautions

Lactation: enters breast milk; use with caution (AAP Committee states compatible with nursing)

Pregnancy-Lactation

Interactions

Concomitant drugs known to prolong QT and increase risk of arrhythmia (eg, class III antiarrhymic agents, CYP3A4 inhibitors by elevating cisapride drug levels, drugs that decrease serum levels of potassium or magnesium). Contraindicated with numerous drugs including those known to cause QT prolongation (eg, tricyclics, certain antipsychotics) or CYP450 3A4 inhibitors (eg, fluconazole, ketoconazole, itraconazole).

Adverse Effects

Side effects of Cisapride : >10% Headache,Diarrhea 1-10% Abdominal pain,Constipation,Tachycardia,Rash,Somnolence,Fatigue,Anxiety,Insomnia,Extrapyramidal effects,Nausea,Sinusitis,Rhinitis,Upper respiratory tract infection,Increased incidence of viral infection <1% Bronchospasm,Gynecomastia,Hyperprolactenemia,Methemoglobinemia,Seizure,Psychiatric disturbances,Apnea

Mechanism of Action

Promotes gastric emptying, increases lower esophageal sphincter tone and esophageal peristalsis Increases gastric motility and cardiac rate possibly by releasing acethylcholine at the myenteric plexus; may act at the serotonin-4 receptor