(for veterinary information only)
BRAND NAME: PROPULSID
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Cisapride represents an improvement over metoclopramide in that the entire GI tract from stomach to colon can gain improved motility with cisapride. Not only stomach contractions are improved but the entire tract motility is improved opening the door to the treatment of constipation disorders. Further, cisapride does not cross into the brain thus providing an alternative to patients that experienced hyperexcitability on metoclopramide.
Cisapride was withdrawn from the human market because when it was combined with any of several commonly prescribed drugs, heart rhythm disturbances ensued. (Often people see different specialist doctors for different body problems and it is not unusual for one doctor to be unaware of the medications that another doctor has prescribed.) Risks outweighed the benefits and now cisapride must be obtained from a compounding pharmacy for veterinary use. The medications that caused problematic interactions are not commonly used in veterinary practice; also, most veterinary patients see only one veterinary practice so the interaction issue is much easier to control for pets.
HOW THIS MEDICATION IS USED
Cisapride is given up to three times daily. It is used to treat nausea due to motility problems in the stomach, though it does not treat the nausea sensation directly in the brain as does its cousin, metoclopramide. It is particularly helpful in patients who have adverse neurologic reactions to metoclopramide but still require stomach motility treatment.
Cisapride may be given with or without food. If a dose is accidentally skipped, do not double up on the next dose.
Because of its effect on smooth muscle contraction, cisapride can also be used in urinary retention situations to strengthen bladder contraction. This use is, at present, uncommon.
If too great a motility effect is created, diarrhea and cramping may result. Vomiting may also result.
Signs of actual overdose include: drooling, incoordination, muscle twitches (and even seizures), agitation and high body temperature.
INTERACTIONS WITH OTHER DRUGS
The drug interaction that led to the removal of cisapride from the human market was the induction of ventricular (heart) arrhythmias when cisapride was used with the antifungal agents ketoconazole or itraconazole or with silymarin, the active ingredient in milk thistle supplements (commonly used to support liver function). Additional medications that could lead to arrhythmias with cisapride include: chloramphenicol (an antibiotic), amiodarone (a heart medication), clarithromycin (an antibiotic), cimetidine (the antacid mentioned above), procainamide (a heart medicine), sotalol (a heart medicine), and of the macrolide class of antibiotics (with the exception of azithromycin), and tricyclic antidepressants such as amitriptylline. The arrhythmias reported in humans have not been reported in animals are are still only theoretical.
CONCERNS AND CAUTIONS
Page last updated: 2/16/2022