Cisapride

Prokinetic, 5-HT4 serotonin receptor agonist (withdrawn EU/US)

ATC code: A03FA02

Brand names: Propulsid

Updated 21 Jul 2026 · Methodology

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Gastroesophageal reflux disease

Not recommended

Cisapride was historically used for gastroesophageal reflux disease and gastroparesis to enhance GI motility. withdrew it in 2000 after reported torsades de pointes and sudden cardiac death, especially with CYP3A4 inhibitors. Not available in Spain. Card retained for historical reference and recognition of dangerous combinations in countries where the drug is still accessible.

Sources

FDA: Propulsid (cisapride) prescribing information withdrawal (2000)

ICD-10: K21 · ICD-11: DA22

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Activates 5-HT4 receptors in the enteric nervous plexus, enhancing acetylcholine release and gut motility. Blocks hERG potassium channels, prolonging QT and triggering torsades de pointes. withdrew the drug in 2000 after reported sudden cardiac deaths. Not available in Spain since 2000.

Safety

Contraindications

Combination with any CYP3A4 inhibitor (macrolides, azoles, ritonavir)
Combination with QT-prolonging drugs
Prior QT prolongation
Severe electrolyte disturbances

Serious adverse effects

Torsades de pointes
Sudden cardiac death

Common adverse effects

Diarrhoea
Abdominal cramps
Headache

Pregnancy: can you take Cisapride?

Drug withdrawn. With accidental early-pregnancy use, no clinically meaningful teratogenicity data.

Breastfeeding: can you take Cisapride?

Passes into breast milk. Breastfeeding not recommended (use not indicated anyway).

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Drug–drug interactions

3 pairs found. Sorted from critical to minor.

CriticalClarithromycinMacrolide antibiotic

Mechanism

Clarithromycin inhibits CYP3A4 – cisapride rises 5-7 fold. Well-known fatal combination, the main reason for cisapride withdrawal in 2000.

Symptoms

Torsades de pointes, sudden cardiac death.

Management

Combination contraindicated.

Sources

Pair details →Clarithromycin →

CriticalItraconazoleAntifungal, triazole

Mechanism

Itraconazole is the strongest CYP3A4 inhibitor. Cisapride rises 10+ fold. Fatal torsades.

Symptoms

Torsades de pointes.

Management

Combination contraindicated.

Sources

Pair details →Itraconazole →

CriticalRitonavirHIV protease inhibitor / pharmacokinetic booster

Mechanism

Ritonavir strongly inhibits the liver enzyme CYP3A4 and slows the breakdown of drugs that depend on it. The US ritonavir label lists cisapride among drugs whose clearance depends heavily on CYP3A and whose raised plasma levels are linked to serious or life-threatening reactions. When the two are taken together, cisapride levels in the blood rise, but the documents give no study with numbers for this pair. With clarithromycin, another strong CYP3A4 inhibitor, the prescribing information reports raised cisapride levels in patients taking both drugs. This can prolong the QT interval on the electrocardiogram and cause ventricular arrhythmias.

Symptoms

The danger of the combination is serious heart rhythm disorders (ritonavir labels). They include QT interval prolongation on the electrocardiogram, ventricular tachycardia, ventricular fibrillation and torsade de pointes (clarithromycin prescribing information on its combination with cisapride). An attack shows as sudden strong palpitations, dizziness or fainting. Prolonged torsade de pointes can turn into ventricular fibrillation and cardiac arrest. Ritonavir itself causes a moderate, symptom-free prolongation of the PR interval in some healthy people. Rare cases of second- or third-degree atrioventricular block have been reported in people with structural heart disease and conduction abnormalities (ritonavir label, European Medicines Agency, ).

Management

The combination is contraindicated (ritonavir label, European Medicines Agency, ; ritonavir label, US Food and Drug Administration, ). The same contraindication appears in the generic ritonavir label (Spanish Agency of Medicines and Medical Devices, AEMPS) and in the label of Paxlovid, where ritonavir is combined with nirmatrelvir (EMA). These documents set no dose condition for cisapride, so the contraindication also covers the low ritonavir doses used to boost other antiviral drugs, including in Paxlovid. When ritonavir boosts another protease inhibitor, also check the contraindications in that drug's label (ritonavir labels, EMA and FDA).

Sources

Pair details →Ritonavir →

Label mentions42 mentions

Verbatim lines from the interaction sections, in the language of the label

From other drugs’ labels

CriticalAmitriptyline
«CONTRAINDICATIONS: Amitriptyline hydrochloride should not be given with cisapride due to the potential for increased QT interval and increased risk for arrhythmia.»
FDA, section 4 · Open on DailyMed
CriticalAtazanavir
«CONTRAINDICATIONS: GI Motility Agent Cisapride»
FDA, section 4 · Open on DailyMed
CriticalBicalutamide
«Está contraindicada la administración concomitante de terfenadina, astemizol o cisaprida con»
AEMPS, section 4.3 · Open on CIMA
CriticalClarithromycin
«La administración concomitante de claritromicina y cualquiera de los siguientes principios activos está contraindicada: astemizol, cisaprida, domperidona, pimozida y terfenadina. Dicha asociación…»
AEMPS, section 4.3 · Open on CIMA
CriticalClarithromycin
«CONTRAINDICATIONS: Cisapride and pimozide (4.2)»
FDA, section 4 · Open on DailyMed
CriticalDarunavir
«cisaprida»
AEMPS, section 4.3 · Open on CIMA
CriticalDronedarone
«Medicamentos que pueden inducir torsades de pointes como fenotiazinas, cisaprida, bepridil, antidepresivos tricíclicos, terfenadina y ciertos macrólidos orales (tales como eritromicina)…»
AEMPS, section 4.3 · Open on CIMA
CriticalErythromycin
«Tratamiento simultáneo con astemizol, terfenadina, disopiramida, cisaprida, pimocida, alcaloides del cornezuelo (como la ergotamina y la dihidroergotamina), simvastatina, atorvastatina o lovastatina.»
AEMPS, section 4.3 · Open on CIMA
CriticalFluconazole
«Está contraindicada la administración de terfenadina a pacientes en tratamiento con dosis múltiples de 400 mg o superiores de fluconazol al día, en base a los resultados de un estudio de…»
AEMPS, section 4.3 · Open on CIMA
CriticalItraconazole
«Antivirales para uso sistémico: Cisaprida»
AEMPS, section 4.3 · Open on CIMA
CriticalKetoconazole
«Drug Interactions: Coadministration of a number of CYP3A4 substrates such as dofetilide, quinidine cisapride and pimozide is contraindicated with ketoconazole tablets. Coadministration with…»
FDA, section 4 · Open on DailyMed
CriticalMiconazole
«Fármacos que prolongan el intérvalo QT, p.ej., mizolastina, pimozida, quinidina, sertindol, terfenadina, astemizol, cisaprida, bepridil, dofetilida, halofantrina, ya que el incremento de las…»
AEMPS, section 4.3 · Open on CIMA
CriticalPimozide
«Está contraindicado el uso concomitante de pimozida con fármacos de los que se conoce su efecto de prolongar el intervalo QT (ver sección 4.3 Contraindicaciones), incluyendo ciertos antiarrítmicos…»
AEMPS, section 4.5 · Open on CIMA
CriticalPosaconazole
«Administración concomitante con los sustratos del CYP3A4 terfenadina, astemizol, cisaprida, pimozida, halofantrina o quinidina, dado que esto puede causar un aumento en las concentraciones…»
AEMPS, section 4.3 · Open on CIMA
CriticalRitonavir
«Agentes que actúan sobre la motilidad gastrointestinal: La coadministración con ritonavir es probable que produzca un aumento de las concentraciones plasmáticas de cisaprida y por tanto está…»
AEMPS, section 4.5 · Open on CIMA
CriticalRitonavir
«CONTRAINDICATIONS: GI Motility Agent: cisapride»
FDA, section 4 · Open on DailyMed
CriticalVoriconazole
«Cisaprida»
AEMPS, section 4.3 · Open on CIMA
CriticalZiprasidone
«Tratamiento concomitante con medicamentos que prolonguen el intervalo QT como antiarrítmicos de Clase IA y III, trióxido de arsénico, halofantrina, acetato de levometadilo, mesoridazina, tioridazina…»
AEMPS, section 4.3 · Open on CIMA
MajorAmitriptyline
«Los fármacos que prolongan el intervalo QT , incluidos antiarritímicos como la quinidina, los antihistamínicos astemizol y terfenadina, algunos antipsicóticos (particularmente la pimozida y el…»
AEMPS, section 4.5 · Open on CIMA
MajorIvabradine
«sertindol, mefloquina, halofantrina, pentamidina, cisaprida, eritromicina intravenosa).»
AEMPS, section 4.5 · Open on CIMA
MajorTicagrelor
«Medicamentos metabolizados por CYP3A4: Ticagrelor es un inhibidor leve del CYP3A4. No se recomienda la administración concomitante de ticagrelor con sustratos del CYP3A4 con índices terapéuticos…»
AEMPS, section 4.5 · Open on CIMA
ModerateAzithromycin
«Medicamentos asociados con prolongación del intervalo QT: Azitromicina se debe usar con precaución en pacientes que reciben medicamentos que se sabe que prolongan el intervalo QT (ver sección 4.4)…»
AEMPS, section 4.5 · Open on CIMA
ModerateChlortalidone
«Sustancias que pueden desencadenar torsades de pointes: - otros: bepridil, cisaprida, difemanil, eritromicina i.v., halofantrina, mizolastina, pentamidina, esparfloxacino, moxifloxacino, vincamina…»
AEMPS, section 4.5 · Open on CIMA
ModerateEverolimus
«Interacciones: Se debe tener precaución cuando se administre everolimus en combinación con sustratos de CYP3A4 administrados por vía oral con un estrecho margen terapéutico, debido a la posibilidad…»
AEMPS, section 4.4 · Open on CIMA
ModerateHydrochlorothiazide
«Medicamentos afectados por alteraciones de los niveles de potasio: Otros medicamentos p.ej., bepridil, cisaprida, difemanilo, eritromicina IV, halofantrina, mizolastina, pentamidina, ciprofloxacino…»
AEMPS, section 4.5 · Open on CIMA
ModerateIndapamide
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: otros fármacos: (ej. bepridil, cisaprida, difemanil, eritromicina IV, halofantrina, mizolastina, pentamidina, esparfloxacino…»
AEMPS, section 4.5 · Open on CIMA
ModerateRivastigmine
«Dado que la bradicardia constituye un factor de riesgo en la aparición de torsades de pointes, se debe observar con precaución e incluso puede requerirse una monitorización clínica (ECG), si se…»
AEMPS, section 4.5 · Open on CIMA
ModerateRupatadine
«Puede requerirse el ajuste de la dosis de sustratos susceptibles del CYP3A4 (p. ej., simvastatina, lovastatina) y sustratos del CYP3A4 con estrecho índice terapéutico (p. ej., ciclosporina…»
AEMPS, section 4.4 · Open on CIMA
Atomoxetine
«Salbutamol (u otros agonistas beta2): Existe un riesgo potencial de prolongación del intervalo QT cuando atomoxetina se administra con otros medicamentos que prolongan el intervalo QT (como…»
AEMPS, section 4.5 · Open on CIMA
Domperidone
«Está contraindicado el uso concomitante de las siguientes sustancias: ciertos medicamentos gastrointestinales (p. ej., cisaprida, dolasetrón, prucaloprida)»
AEMPS, section 4.5 · Open on CIMA
Eplerenone
«Sustratos CYP3A4: Resultados de los estudios farmacocinéticos con sustratos CYP3A4, por ejemplo midazolam y cisaprida, no mostraron interacciones farmacocinéticas significativas cuando estas…»
AEMPS, section 4.5 · Open on CIMA
Fluvoxamine
«Casos de incremento de efectos adversos: Terfenadina, astemizol, cisaprida, sildenafilo (ver también sección 4.4).»
AEMPS, section 4.5 · Open on CIMA
Lithium
«Otros : trióxido de arsénico, cisaprida y ranolazina»
AEMPS, section 4.5 · Open on CIMA
Methadone
«Metadona y prolongación del intérvalo QT: El riesgo de metadona de prolongar el intervalo QT puede verse aumentado cuando se administra con medicamentos que producen alteraciones electrolíticas y con…»
AEMPS, section 4.5 · Open on CIMA
Moxifloxacin
«Interacciones con otros medicamentos: otros (cisaprida, vincamina IV, bepridil, difemanilo).»
AEMPS, section 4.5 · Open on CIMA
Nifedipine
«Cisaprida: La administración simultánea de cisaprida y nifedipino puede producir un aumento de las concentraciones plasmáticas de nifedipino.»
AEMPS, section 4.5 · Open on CIMA
Sirolimus
«Pueden observarse interacciones farmacocinéticas con agentes procinéticos gastrointestinales, como cisaprida y metoclopramida.»
AEMPS, section 4.5 · Open on CIMA
Sirolimus
«Weak and Moderate Inducers or Inhibitors of CYP3A4 and P-gp: Drugs that could increase sirolimus blood concentrations: Bromocriptine, cimetidine, cisapride, clotrimazole, danazol, diltiazem…»
FDA, section 7 · Open on DailyMed
Solifenacin
«Interacciones farmacológicas: La solifenacina puede reducir el efecto de los medicamentos que estimulan la motilidad del tubo digestivo, como metoclopramida y cisaprida.»
AEMPS, section 4.5 · Open on CIMA
Terbinafine
«Drug-Drug Interactions: In vitro studies with human liver microsomes showed that terbinafine does not inhibit the metabolism of tolbutamide, ethinylestradiol, ethoxycoumarin, cyclosporine, cisapride…»
FDA, section 7 · Open on DailyMed

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Frequently asked

What is Cisapride used for?

Cisapride is evaluated for the following indications with varying evidence strength: Gastroesophageal reflux disease (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Cisapride?

Common side effects of Cisapride (≥ 1 in 100): Diarrhoea, Abdominal cramps, Headache. See the Safety section for uncommon and serious reactions.

Is Cisapride safe during pregnancy?

Drug withdrawn. With accidental early-pregnancy use, no clinically meaningful teratogenicity data.

Is Cisapride compatible with breastfeeding?

Passes into breast milk. Breastfeeding not recommended (use not indicated anyway).

Who should not take Cisapride?

Cisapride is contraindicated in: Combination with any CYP3A4 inhibitor (macrolides, azoles, ritonavir); Combination with QT-prolonging drugs; Prior QT prolongation; Severe electrolyte disturbances. Full list in the Safety section.

Other drugs in this group

Domperidone, Drotaverine, Hyoscine butylbromide, Mebeverine, Otilonium bromide, Trimebutine, Metoclopramide, Simeticone