Cisapride in chronic idiopathic constipation: can the colon be re-educated? Bavarian Constipation Study Group.
OBJECTIVE
To investigate whether dose tapering and, potentially, withdrawal of cisapride is possible without loss of therapeutic effect.


METHODS
A total of 119 patients with chronic constipation (less than three spontaneous, i.e., not laxative-induced, stools per week).


METHODS
Randomized double-blind study.


METHODS
Group A (n = 56) was treated with cisapride 20 mg twice daily for 12 weeks. Treatment was continued for a further 12 weeks during which the patients were allowed to take a maximum of four tablets containing 5 mg cisapride each (maximum daily dose, 20 mg). Group B (n = 63) was treated with cisapride 20 mg twice daily for 6 weeks and then with cisapride 10 mg for 6 weeks. Treatment was then stopped and follow-up was continued for a further 12 weeks.


RESULTS
Stool frequency was increased in both groups during active treatment and was not reduced when the dose was decreased from 20 mg to 10 mg twice daily in group B but was maintained in group A. Laxative intake fell by 50% in both groups, but this effect was maintained during follow-up in group A only. Group A patients took nearly the maximum dosage of cisapride tablets allowed during follow-up (3.3 tablets per day +/- 0.2 SEM).


CONCLUSIONS
This study confirmed the efficacy of cisapride in chronic idiopathic constipation. Dose tapering below 15-20 mg per day, however, does not appear to be possible.
Müller-Lissner
S A
SA
Department of Internal Medicine, Weissensee Hospital, Berlin, Germany.
D000328:Adult; D002908:Chronic Disease; D020117:Cisapride; D003106:Colon / Q000503:physiopathology; D003248:Constipation / Q000188:drug therapy* / Q000503:physiopathology; D003672:Defecation; D004311:Double-Blind Method; D006801:Humans; D010880:Piperidines / Q000627:therapeutic use*
D010880:Piperidines; D020117:Cisapride