cisapride (Rx)

Brand and Other Names:Propulsid
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

Available through investigational limited access program

Gastrointestinal Dysmotility

5-10 mg PO q6hr at least 15 minutes PC and HS

May need to increase to 20 mg in some patients

Dosage Forms & Strengths

Available through investigational limited access program

Gastrointestinal Dysmotility

0.15-0.3 mg/kg/dose PO q6-8hr; not to exceed 10 mg/dose  

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Interactions

Interaction Checker

and cisapride

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (13)

            • albuterol

              albuterol and cisapride both increase QTc interval. Contraindicated.

            • alfuzosin

              alfuzosin and cisapride both increase QTc interval. Contraindicated.

            • apomorphine

              apomorphine and cisapride both increase QTc interval. Contraindicated.

            • arformoterol

              arformoterol and cisapride both increase QTc interval. Contraindicated.

            • aripiprazole

              aripiprazole and cisapride both increase QTc interval. Contraindicated.

            • artemether

              artemether and cisapride both increase QTc interval. Contraindicated.

            • atomoxetine

              atomoxetine and cisapride both increase QTc interval. Contraindicated.

            • ceritinib

              ceritinib and cisapride both increase QTc interval. Contraindicated.

            • clarithromycin

              clarithromycin and cisapride both increase QTc interval. Contraindicated.

            • dofetilide

              dofetilide increases toxicity of cisapride by QTc interval. Contraindicated.

            • escitalopram

              escitalopram increases toxicity of cisapride by QTc interval. Contraindicated.

            • levoketoconazole

              levoketoconazole increases levels of cisapride by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

              cisapride and levoketoconazole both increase QTc interval. Contraindicated.

            • mifepristone

              mifepristone, cisapride. QTc interval. Contraindicated.

            Serious - Use Alternative (16)

            • abametapir

              abametapir will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • azithromycin

              azithromycin increases toxicity of cisapride by QTc interval. Avoid or Use Alternate Drug.

            • chloroquine

              chloroquine increases toxicity of cisapride by QTc interval. Avoid or Use Alternate Drug.

            • citalopram

              citalopram and cisapride both increase QTc interval. Avoid or Use Alternate Drug.

            • clozapine

              clozapine and cisapride both increase QTc interval. Avoid or Use Alternate Drug.

            • dasatinib

              dasatinib and cisapride both increase QTc interval. Avoid or Use Alternate Drug.

            • degarelix

              degarelix and cisapride both increase QTc interval. Avoid or Use Alternate Drug.

            • hydrocortisone

              hydrocortisone will decrease the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate increases toxicity of cisapride by QTc interval. Avoid or Use Alternate Drug.

            • levoketoconazole

              levoketoconazole will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • lopinavir

              lopinavir will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • mifepristone

              mifepristone will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • ponesimod

              ponesimod, cisapride. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

            • saquinavir

              saquinavir increases levels of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increased risk of QT prolongation and cardiac arrhythmias.

            • tipranavir

              tipranavir will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • tucatinib

              tucatinib will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            Monitor Closely (13)

            • atogepant

              cisapride will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bosutinib

              bosutinib and cisapride both increase QTc interval. Use Caution/Monitor.

            • capecitabine

              capecitabine and cisapride both decrease QTc interval. Use Caution/Monitor.

            • desflurane

              desflurane and cisapride both increase QTc interval. Use Caution/Monitor.

            • desipramine

              desipramine and cisapride both increase QTc interval. Use Caution/Monitor.

            • deutetrabenazine

              deutetrabenazine and cisapride both increase QTc interval. Use Caution/Monitor.

            • dolasetron

              dolasetron and cisapride both increase QTc interval. Use Caution/Monitor.

            • donepezil

              donepezil and cisapride both increase QTc interval. Use Caution/Monitor.

            • efavirenz

              efavirenz and cisapride both increase QTc interval. Use Caution/Monitor.

            • finerenone

              cisapride will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • isavuconazonium sulfate

              cisapride will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • selpercatinib

              selpercatinib increases toxicity of cisapride by QTc interval. Use Caution/Monitor.

            Minor (3)

            • isavuconazonium sulfate

              isavuconazonium sulfate will increase the level or effect of cisapride by Other (see comment). Minor/Significance Unknown. Isavuconazonium sulfate, an OCT2 inhibitor, may increase the effects or levels of OCT2 substrates.

            • ribociclib

              ribociclib will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • ruxolitinib topical

              cisapride will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Headache

            Diarrhea

            1-10%

            Abdominal pain

            Constipation

            Tachycardia

            Rash

            Somnolence

            Fatigue

            Anxiety

            Insomnia

            Extrapyramidal effects

            Nausea

            Sinusitis

            Rhinitis

            Upper respiratory tract infection

            Increased incidence of viral infection

            <1%

            Bronchospasm

            Gynecomastia

            Hyperprolactinemia

            Methemoglobinemia

            Seizure

            Psychiatric disturbances

            Apnea

            Postmarketing Reports

            Serious cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation, torsades de pointes, and QT prolongation reported primarily in patients with known risk factors

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            Warnings

            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

            Monitoring

            • 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

            Contraindications

            Hypersensitivity

            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 antiarrhythmic 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 lengthy list of disallowed medications must be reviewed to assure the patient is not taking drugs that may result in serious or life-threatening interactions

            Cautions

            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

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: enters breast milk; use with caution (AAP Committee states compatible with nursing)

            Pregnancy Categories

            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.

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            Pharmacology

            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 acetylcholine at the myenteric plexus; may act at the serotonin-4 receptor

            Pharmacokinetics

            Onset of action: 0.5-1 hr

            Bioavailability: 35-40%

            Half-life: 6-12 hr

            Protein binding: 97.5-98%

            Metabolism: Liver

            Excretion: Urine and feces

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            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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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.

            Tier Description
            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.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            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 step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.