Dosing & Uses
Dosage Forms & Strengths
Available through investigational limited access program
5-10 mg PO q6hr at least 15 minutes PC and HS
May need to increase to 20 mg in some patients
Serious - Use Alternative
Significant - Monitor Closely
Upper respiratory tract infection
Increased incidence of viral infection
Serious cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation, torsades de pointes, and QT prolongation reported primarily in patients with known risk factors
Black Box Warnings
Cardiovascular: Serious cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation, torsades de pointes, and QT prolongation; risk factors include concurrent therapy with drugs known to cause QT prolongation or depletion of serum electrolytes
Drug Interactions: Contraindicated with numerous drugs including those known to cause QT prolongation (eg, tricyclics, certain antipsychotics) or CYP450 3A4 inhibitors (eg, fluconazole, ketoconazole, itraconazole); see list of disallowed medications at www.propulsid-lap.com
Do not exceed recommended doses
Available only via a limited access program for patients meeting requirements; 222.propulsid-lap.com
- Perform baseline 12-lead ECG
- Do not initiate therapy if QTc >450 msec
- Assess serum electrolyte and creatinine levels before initiating and whenever condition develops affecting electrolyte balance or renal function
- Discontinue drug if syncope, tachycardia, or arrhythmia develops
Serious cardiac arrhythmias (eg, ventricular fibrillation, torsades de pointes, and QT prolongation) reported in patients taking cisapride with other drugs that inhibit cytochrome CYP3A4 or have additive QT prolonging effect; some of these events have been fatal
Patient history or family history of prolonged QT syndrome
History of renal failure, ventricular arrhythmias, ischemic heart disease, CHF, clinically significant bradycardia, uncorrected electrolyte disorders (eg, hypomagnesemia, hypokalemia), and respiratory failure
Concomitant drugs known to prolong QT and increase risk of arrhythmia (eg, class III antiarrhymic agents, CYP3A4 inhibitors by elevating cisapride drug levels, drugs that decrease serum levels of potassium or magnesium)
Upon requesting cisapride through the compassionate use program, a lenthy list of disallowed medications must be reviewed to assure the patient is not taking drugs that may result in serious or life-threatening interactions
Decrease dose by 50% with liver impairment
Potential benefits should be weighed against risks prior to initiating therapy in patients that may develop prolongation of cardiac conduction intervals, especially QTc
Serious cardiac arrhythmias, tachycardia, ventricular fibrillation, torsade de pointes, and QT prolongation reported in patients taking CYP3A4 inhibitors
Not for use in patients that might experience rapid reduction of plasma potassium as those resulting from potassium wasting diuretics and/or insulin in acute settings
Pregnancy & Lactation
Pregnancy Category: C
Lactation: enters breast milk; use with caution (AAP Committee states compatible with nursing)
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Metabolism: hepatic P450 enzyme CYP3A4
Mechanism of Action
Promotes gastric emptying, increases lower esophageal sphincter tone and esophageal peristalsis
Increases gastric motility and cardiac rate possibly by releasing acethylcholine at the myenteric plexus; may act at the serotonin-4 receptor
Onset of action: 0.5-1 hr
Half-life: 6-12 hr
Protein binding: 97.5-98%
Excretion: Urine and feces
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.