CISAPRIDE

(for veterinary information only)

BRAND NAME: PROPULSID

Available only via
compounding pharmacies

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Cisapride was withdrawn from the human market because when it was combined with any of several commonly prescribed drugs, heart rhythm disturbances ensued.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.) Human risk and legal liability were felt to outweigh the human benefits and the drug was removed from the market; veterinary patients must employ a compounding pharmacy to obtain cisapride. The heart rhythm side effect appears to be limited to the human population and pets have not been affected.

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 has been found helpful in some cases of megaesophagus and is a common treatment for feline megacolon.

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.

SIDE EFFECTS

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 antacids cimetidine and ranitidine will have enhanced activity in patients on cisapride.
• Cisapride enhances the sedating properties of the benzodiazepine drugs (such as diazepam or alprazolam).
• Cisapride enhances the sedating properties of alcohol (generally not a concern in veterinary patients.).
• Cisapride works less well with the concurrent use of medications with anticholinergic side effects (antihistamines, some heart medications, some psychoactive 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

• Cisapride products should be stored in accordance with the recommendations of compounding pharmacy where they were made.
• If there is question about an actual intestinal obstruction or perforation, it is best not to use a motility modifier such as cisapride.
• Cisapride is not felt to be safe during pregnancy and may also reduce fertility in females taking the drug.

Short version (to help us comply with "Lizzie's Law")

Page last updated: 2/8/2024