Cisapride is a medication that was previously used to treat gastrointestinal disorders such as gastroesophageal reflux disease (GERD) and gastroparesis. However, it has been withdrawn from the market in many countries due to serious side effects, including cardiac arrhythmias and sudden death.
Studies have shown that Cisapride can cause a potentially fatal heart rhythm disturbance called QT prolongation[1], which can lead to torsades de pointes, a type of ventricular tachycardia[2] that can cause sudden death. This risk is increased in patients with underlying heart disease, electrolyte imbalances, or who are taking other medications that can also prolong the QT interval.
In addition to cardiac arrhythmias, Cisapride has also been associated with other side effects such as headache, diarrhea, abdominal pain, and nausea. Due to the risks and potential harm associated with Cisapride, it has been largely replaced by safer alternatives such as proton pump inhibitors and prokinetic agents.
Veterinary
Cisapride is a medication that stimulates the motility of the gastrointestinal tract and is commonly used in veterinary medicine to treat disorders such as gastric stasis and megacolon[3] in cats.
Cisapride works by increasing the release of acetylcholine[4] in the gut, which stimulates the contraction of smooth muscle and improves gastrointestinal motility[5]. It has been shown to be effective in the treatment of a variety of gastrointestinal disorders in cats and dogs, including chronic constipation and megacolon.
One study found that cisapride was effective in improving clinical signs in 94% of cats with idiopathic, an unknown cause of, megacolon, a condition characterized by severe constipation and colonic dilation. Another study found that cisapride was effective in treating gastric inactivity in rabbits, a condition that can lead to life-threatening complications such as gastric dilation and volvulus, a twisting, of the intestine, causing intestinal obstruction. In conclusion, cisapride can be an effective medication for treating gastrointestinal motility disorders in animals, particularly cats and rabbits. However, it should only be used under the careful supervision of a veterinarian.
Footnotes
- QT prolongation is a condition characterized by an abnormality in the electrical activity of the heart that leads to an elongation of the QT interval on an electrocardiogram (ECG). The QT interval is a measure of the time it takes for the heart to depolarize and repolarize, and a prolonged QT interval can lead to a dangerous heart rhythm called torsades de pointes, which can cause sudden cardiac death. QT prolongation can be caused by a variety of factors, including certain medications, electrolyte imbalances, and genetic predisposition. Medications that are known to prolong the QT interval include antiarrhythmic agents, antibiotics, antipsychotics, and antidepressants. [Back]
- Ventricular tachycardia (VT) is a type of arrhythmia that originates in the ventricles, the lower chambers of the heart. It is characterized by a rapid heart rate (greater than 100 beats per minute) and can lead to decreased cardiac output and hemodynamic instability. VT can be a life-threatening condition, particularly if it degenerates into ventricular fibrillation, which is a type of cardiac arrest. VT can be caused by a variety of factors, including underlying heart disease, electrolyte imbalances, medications, and genetic abnormalities. In some cases, VT can occur without an identifiable cause, which is known as idiopathic VT. [Back]
- Gastric stasis, also known as gastroparesis, is a condition in which the stomach does not empty its contents properly. This can lead to a buildup of food and gas in the stomach, which can cause discomfort, vomiting, and other digestive problems. Gastric stasis can be caused by a variety of factors, including neurological disorders, medication side effects, and metabolic disorders. Megacolon, on the other hand, is a condition in which the colon becomes abnormally enlarged and loses its ability to contract and move stool along the digestive tract. This can lead to chronic constipation, which can cause abdominal pain, vomiting, and other health problems. Megacolon can be caused by a variety of factors, including neurological disorders, dehydration, and chronic constipation. [Back]
- Acetylcholine (ACh) is a neurotransmitter – a chemical messenger that transmits signals between nerve cells – found in both the central nervous system (CNS) and the peripheral nervous system (PNS) of animals, including humans. It is the first neurotransmitter to have been identified and plays a crucial role in the regulation of many physiological processes, including muscle movement, heart rate, digestion, and memory formation. [Back]
- Gastrointestinal (GI) motility refers to the coordinated movement of food, fluids, and waste products through the digestive tract, which is essential for digestion, absorption, and elimination. GI motility involves the contraction and relaxation of smooth muscles in the esophagus, stomach, small intestine, colon, and rectum, as well as the regulation of these contractions by the enteric nervous system, autonomic nervous system, and hormones. Alterations in GI motility can result in a variety of clinical conditions, including constipation, diarrhea, and motility disorders such as gastroparesis and irritable bowel syndrome. Understanding the mechanisms and regulation of GI motility is important for the diagnosis and treatment of these conditions. [Back]
Further Reading
Sources
- Cisapride: A review of its pharmacological properties and therapeutic potential in functional gastrointestinal disorders. Drugs. 1994 Apr;47(4):116-32. doi: 10.2165/00003495-199447040-00007. PMID: 7511419.
- FDA. “Cisapride (marketed as Propulsid) Information.” https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/cisapride-marketed-propulsid-information.
- Hill, K. & Farrier, J. (2005). “Cisapride: What went wrong?” Prescriber, 16(4), 47-51. https://doi.org/10.1002/psb.6.
- Kannankeril, P. J., & Roden, D. M. (2009). Drug-induced long QT and torsade de pointes: recent advances. Current opinion in cardiology, 24(1), 33-39.
- Tisdale, J. E. (2017). Drug-induced QT interval prolongation and torsades de pointes: Role of the pharmacist in risk assessment, prevention and management. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada, 150(2), 118-129.
- Drew, B. J., Ackerman, M. J., Funk, M., Gibler, W. B., Kligfield, P., Menon, V., … & American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation. (2010). Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Journal of the American College of Cardiology, 55(9), 934-947.
- Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol. 2006;48:e247-e346.
- Aliot EM, Stevenson WG, Almendral-Garrote JM, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace. 2009;11:771-817.
- Belhassen B, Glick A, Viskin S. Idiopathic ventricular tachycardia. Circulation. 1998;97:538-549.
- “Gastroparesis in Cats – Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost.” Wag! Walking, 2021, wagwalking.com/cat/condition/gastroparesis.
- “Megacolon in Cats – Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost.” Wag! Walking, 2021, wagwalking.com/cat/condition/megacolon.
- Camilleri, M. (2018). Gastrointestinal motility disorders. In Sleisenger and Fordtran’s Gastrointestinal and Liver Disease (pp. 348-370). Elsevier.
- Mearin, F., Lacy, B. E., & Chang, L. (2016). Bowel disorders. Gastroenterology, 150(6), 1393-1407.
- Stanghellini, V., Chan, F. K., Hasler, W. L., Malagelada, J. R., Suzuki, H., & Tack, J. (2017). Gastroduodenal disorders. Gastroenterology, 153(4), 1192-1207.
