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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Prokinetic agents stimulate upper gastrointestinal tract motility and are used primarily for the treatment of gastrointestinal reflux. Two agents are currently available in this class: cisapride (Propulsid) and metoclopramide (Reglan). Among 88 infants born to women who used cisapride during the first trimester, the frequency of congenital anomalies was not increased (Bailey et al., 1997). In Swedish Registry, 106 infants were exposed to cisapride during the first trimester, and the frequency of birth defects was not increased (Kallen, 2019).
Rational Medical Therapy of Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Richard M. Sperling, Kenneth R. McQuaid
Given the excellent safety profile of H2-antagonists, an empirical trial would appear to be a reasonable first choice in most refractory NUD patients, particularly those with some symptoms of reflux. In the 35-80% who experience improvement, it is impossible to know whether this represents a placebo response. The physician is then in the difficult position of having to decide whether to withdraw a drug that the patient feels is beneficial or to continue something that may be nothing more than a costly placebo. A trial off drug therapy may be warranted. Patients who fail to improve on H2-antagonists may benefit from a trial of a promotility agent. Cisapride is the preferred agent because of its lack of side effects and excellent safety profile. Metoclopramide is less expensive, but the higher incidence of side effects limits its utility. Therapy directed at H. pylori eradication cannot be recommended at this time outside of clinical trials.
Section 9
Published in Padmanabhan Ramnarayan, MCQs in Paediatrics for the MRCPCH, Part 1, 2017
Cisapride is a prokinetic drug that reduces gastric emptying time. It is not licensed for use in children in the UK. QT abnormalities are reported with therapy especially when given with erythromycin or antifungal drugs like ketoconazole (enzyme inhibitor) and have caused fatal arrythmias. This is especially common in children with a prolonged QT syndrome.
Current and emerging therapeutic options for the management of functional dyspepsia
Published in Expert Opinion on Pharmacotherapy, 2020
A. Vandenberghe, J. Schol, K. Van den Houte, I. Masuy, F. Carbone, J. Tack
Cisapride is a 5-HT4-receptor agonist and 5- HT3-receptor antagonist developed at the end of last century, indicated for nocturnal heartburn and regurgitations in adults, and reflux or regurgitations in neonates [37]. It was the leading prokinetic, mainly prescribed for dyspeptic symptoms and other upper gastrointestinal motility disorders, up to its withdrawal in the year 2000 due to its affinity for the human ether-a-gogo (HERG) channel, responsible for cardiac arrhythmias [37]. In absence of alternative drugs, a post-marketing surveillance program took place and a few gastroenterologists and endocrinologists in some European countries continued to prescribe cisapride in gastroparesis patients. However, the program was discontinued in 2006. In neonates, PPIs, which can decrease the volume of gastric secretion, replaced the banned prokinetic with mitigated results. The therapeutic gap left by cisapride remains to be filled up to now, and based on current evidence, only acotiamide may have some potential to replace it.
Use of prucalopride in adults with chronic idiopathic constipation
Published in Expert Review of Clinical Pharmacology, 2019
Priya Vijayvargiya, Michael Camilleri
There are seven isoforms of the 5-HT receptor. 5-HT4 isoform is found in the human body within the alimentary tract, substantia nigra, and cardiac system. Because 5-HT4 receptors are also found within the heart, there is a concern for receptor cross-reactivity, similar to previous 5-HT4 receptor agonists such as cisapride and tegaserod. However, there are differences between these three prokinetic agents. An important distinction is that cisapride interacts with the human ether-a-go-go [hERG] potassium channel, resulting in cardiac arrhythmias such as ventricular tachycardia, ventricular fibrillations, torsade de pointes, and QTc interval prolongation. Because of the risk of cardiac arrhythmias, cisapride was withdrawn from the market in July 2000, though it has subsequently become available in some countries, but not in the United States. Tegaserod was associated with ischemic or vascular events secondary to the concomitant activation of 5-HT1D and 5-HT2A receptors [21].
Gastroparesis: pharmacotherapy and cardiac risk
Published in Scandinavian Journal of Gastroenterology, 2018
Per M. Hellström, Ahmad Al-Saffar
5-HT is highly abundant in the gastrointestinal tract, both in the mucosa and enteric nervous system. 5-HT, in general, but particularly when binding to 5-HT4 receptors, plays an important role in regulation of gastrointestinal motility and as mediator of enteric neuronal signaling. Cisapride, tegaserod and prucalopride are three major agonists of this class. Cisapride was initially found to be a strong stimulator of gastric emptying, but marketing of the drug was terminated in 2000, due to its risk of prolonging the QT-interval and TdP [8].