Cisapride

Brand

Propulsid

Availability

Although no longer commercially available in the USA, it may be obtained through a compounding pharmacy.

  • Tablets: 10 mg, 20 mg
  • Suspension: 1 mg/mL

Pharmacology

Structurally related to procainamide but pharmacologically different, cisapride is an oral prokinetic drug.
It both increases and promotes lower esophageal peristalsis and sphincter pressure, but does not increase gastric acid secretion. It speeds gastric emptying.

Cisapride is rapidly absorbed and well distributed. At high dosages cisapride can cause impaired fertility in female rats, as well as being both embryotoxic and fetotoxic. Cisapride is found to be excreted in breast milk in low levels. The drug is eliminated in urine and feces.

Indications

Used in some types of megacolon and chronic constipation, it is of no benefit in rats with aganglionic megacolon. Also, due to potential for tissue injury as a result of hard stool being push through the bowel by forceful movement, it is no longer advised to use in rats with constipation. Where benefit is thought to be greater than the risk of its use, caution is advised.

Drug Interactions or Contraindications

  • Do not give in GI perforation and hemorrhage.
  • Ketoconazole, miconazole, erythromycin, clarithromycin, troleandomycin, nefazodone, fluconazole, itraconazole, indinavir, and ritonavir, inhibit metabolism of cisapride and increase the risk of cardiac arrhythmias. Do not give together.

Adverse Reactions

Serious toxicity can develop with this agent, do not overdose.

CV: ventricular tachycardia, torsades de pointes, QT prolongation

GI: diarrhea, and abdominal pain

Dosage Recommendations

0.2 mg/lb to 0.4 mg/lb (if using this dose range in lbs and changing to kg, it will be 0.44 mg/kg to 0.88 mg/kg). 4

or

0.1 mg/kg to 0.5 mg/kg, PO, q8hr to q12hr 41

or

0.1 mg/kg to 0.5 mg/kg, PO, q12hr  1, 27

Considerations

  • Not known to be effective in baby rats.
  • Not of benefit in rats with aganglionic megacolon.
  • Caution when giving other oral medications with cisapride, since it may affect their absorption due to its action of decreasing GI transit time.
  • Administer on empty stomach at least 15 minutes before eating for consistent absorption.
  • Store at room temperature and protect from light.

Cross-references

Links to

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