Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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 (15)
- 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 (15)
- 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. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- 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.
- lenacapavir
lenacapavir will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- 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.
- valbenazine
valbenazine and cisapride both increase QTc interval. Use Caution/Monitor.
Minor (7)
- acetazolamide
acetazolamide will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- 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.
- larotrectinib
larotrectinib will increase the level or effect of cisapride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- 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.
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
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
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.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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