Drug Groups

approved; withdrawn; investigational

Description

In many countries (including Canada) cisapride has been either withdrawn or has had its indications limited due to reports about long QT syndrome due to cisapride, which predisposes to arrhythmias. The FDA issued a warning letter regarding this risk to health care professionals and patients.

Indication

For the symptomatic treatment of adult patients with nocturnal heartburn due to gastroesophageal reflux disease.

Pharmacology

Cisapride is a parasympathomimetic which acts as a serotonin 5-HT₄ agonist. Stimulation of the serotonin receptors increases acetylcholine release in the enteric nervous system. Cisapride stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. Cisapride increases the tone and amplitude of gastric (especially antral) contractions, relaxes the pyloric sphincter and the duodenal bulb, and increases peristalsis of the duodenum and jejunum resulting in accelerated gastric emptying and intestinal transit. It increases the resting tone of the lower esophageal sphincter. It has little, if any, effect on the motility of the colon or gallbladder. Cisapride does not induce muscarinic or nicotinic receptor stimulation, nor does it inhibit acetylcholinesterase activity.

Affected Organisms

Biotransformation

Hepatic. Extensively metabolized via cytochrome P450 3A4 enzyme.

Absorption

Cisapride is rapidly absorbed after oral administration, with an absolute bioavailability of 35-40%.

Half Life

6-12 hours

Protein Binding

97.5%

References

External Links