Prokinetic, 5-HT4 serotonin receptor agonist (withdrawn EU/US)
ATC code: A03FA02 (Cisapride)
Brand names
Propulsid
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.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
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 Card retained for historical reference and recognition of dangerous combinations in countries where the drug is still accessible.
2 pairs found. Sorted from critical to minor.
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.
Mechanism
Itraconazole is the strongest CYP3A4 inhibitor. Cisapride rises 10+ fold. Fatal torsades.
Symptoms
Torsades de pointes.
Management
Combination contraindicated.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Drug withdrawn. With accidental early-pregnancy use, no clinically meaningful teratogenicity data.
Passes into breast milk. Breastfeeding not recommended (use not indicated anyway).
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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.
Common side effects of Cisapride (≥ 1 in 100): Diarrhoea, Abdominal cramps, Headache. See the Safety section for uncommon and serious reactions.
FDA category C. Drug withdrawn. With accidental early-pregnancy use, no clinically meaningful teratogenicity data.
Passes into breast milk. Breastfeeding not recommended (use not indicated anyway).
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.