Please Note: This Drug has been discontinued.
GENERIC NAME: cisapride
BRAND NAME: Propulsid
IMPORTANT NEWS ALERT - The U.S. Food and Drug Administration (FDA) has issued an urgent warning regarding cisapride (Propulsid) which has been found to cause cardiac arrhythmias (irregular heart rhythms).
All patients taking cisapride have been advised to contact their
doctors. The manufacturer of cisapride, Janssen Pharmaceutica, will
remove cisapride from pharmacies by July of 2000; however, Janssen
plans to make the drug available for patients with unusual,
debilitating problems for whom there is no alternative
therapy.
DRUG CLASS AND MECHANISM: Cisapride is a
"prokinetic"
agent that increases muscle contractions of the lower esophagus
and the
lower esophagus sphincter. The lower esophagus sphincter,
located between
the esophagus and stomach, normally prevents reflux of acid and
other
stomach contents into the esophagus. In patients with
Gastroesophageal Reflux
(GERD),
a weakened lower esophagus sphincter allows reflux of stomach
acid into
the esophagus, causing heart burn and acid damage to the
esophagus (peptic
esophagitis). Cisapride, like metoclopramide (Reglan),
decreases stomach
acid reflux by strengthening the lower esophagus sphincter, as
well as the
peristaltic muscle contractions of the lower esophagus. These
two
medications also hasten the stomach emptying of solid and
liquid meals
into the intestines. Faster emptying of meals decrease the
reflux of
stomach acid and other contents into the esophagus.
While cisapride and Reglan are similar in decreasing
gastroesophageal
reflux, Reglan is more likely to cause nervous system side
effects such as
jitteriness, insomnia, sedation, or anxiety.
PRESCRIPTION: yes
GENERIC AVAILABLE: no
PREPARATIONS: tablets: 10mg and 20mg
STORAGE: Tablets should be kept in a tight container and
protected from light and moisture. Temperature should be kept
between
15-30C (59-86F).
PRESCRIBED FOR: Cisapride is used for patients with
heartburn
and esophagitis due to gastroesophageal reflux. For further
information,
please read the GERD
article.
DOSING: Cisapride is given four times daily, 15 minutes
before
each meal and at bedtime. Anticholinergic medications can
decrease the
beneficial effect of cisapride.
DRUG INTERACTIONS: Cisapride should be avoided in
patients
suffering from intestinal obstruction or perforation. Since
cisapride
accelerates stomach emptying, it can increase absorption and
effects of
other medications. For example, the effects of sedatives such
as alcohol
and diazepam (Valium) can be accelerated when used together with
cisapride.
Oral anticoagulant (Coumadin) may have increased effects in
some patients
also taking cisapride. The coagulation times (protimes) may
need to be
closely monitored to avoid excessive anticoagulation and risks
of
bleeding. Safety in children has not been established.
PREGNANCY: Safety in pregnancy has not been
established.
NURSING MOTHERS: Safety in nursing mothers has not been
established.
SIDE EFFECTS: Cisapride is generally well tolerated.
The most
common side affects include headache, diarrhea, nausea,
abdominal pain,
and constipation. Rarely, seizures, abnormal liver tests, fast
heart rates
have been reported. But the relationship of cisapride to these
events were
not clear.
Last Editorial Review: 3/27/2000
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