Cisapride: a gastrointestinal prokinetic drug.
OBJECTIVE
To summarize the pharmacology, pharmacokinetics, efficacy, and safety of cisapride, and to evaluate its potential therapeutic role.


METHODS
A computerized search of the MEDLINE database was used to identify English-language publications of cisapride data in humans. The MEDLINE search was supplemented by review article bibliographies. There was no attempt to limit the search to a specific gastrointestinal motility disorder.


METHODS
The MEDLINE search alone identified 165 citations. Because of the volume of available human cisapride data, the focus of the efficacy section is on complete published reports of controlled clinical studies. Abstracts and uncontrolled data are discussed only when other information is unavailable to address important aspects.


METHODS
Information regarding study design, study population, results, and safety was recorded from each publication. The placebo response to gastrointestinal complaints in patients with motility disorders is high. Therefore, objective evidence of improvement was emphasized when documentation was available.


RESULTS
Cisapride stimulates the motility of smooth muscle lining the esophagus, stomach, small intestine, and colon, and increases the tone of gut sphincters in vitro and in vivo. In controlled investigations, cisapride was superior to placebo in relieving symptoms associated with reflux esophagitis, nonulcer dyspepsia, and gastroparesis. Similar symptom and healing effects were observed with cisapride and histamine (H)2-antagonists in reflux esophagitis. Cisapride was either equal to or superior to metoclopramide in relieving reflux symptoms. However, metoclopramide was associated with significantly more central nervous system adverse effects. Cisapride was well tolerated, with adverse effects limited primarily to the gastrointestinal tract.


CONCLUSIONS
Cisapride represents an attractive alternative to metoclopramide for the treatment of a variety of motility disorders. Because it addresses a primary underlying cause of reflux esophagitis, cisapride may also prove to be an effective alternative to acid suppressants in the management of this disorder.
Department of Pharmacy Practice and Administration, College of Pharmacy, Rutgers State University of New Jersey, Piscataway 08855.
J A
JA
Barone
L M
LM
Jessen
J L
JL
Colaizzi
R H
RH
Bierman
D000328:Adult; D000897:Anti-Ulcer Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D020117:Cisapride; D002986:Clinical Trials as Topic; D003248:Constipation / Q000188:drug therapy; D004311:Double-Blind Method; D004415:Dyspepsia / Q000188:drug therapy; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010277:Parasympathomimetics / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D010880:Piperidines / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D010277:Parasympathomimetics; D010880:Piperidines; D020117:Cisapride