Does cisapride influence cardiac rhythm? Results of a United States multicenter, double-blind, placebo-controlled pediatric study.
BACKGROUND
Major concerns about serious cardiac side effects underlie the recent decision by the FDA and Janssen Pharmaceutica (Titusville, NJ) to make cisapride available only through a limited access program. Concerns have grown despite the fact that most instances of prolonged QTc and other ventricular arrhythmias occurred while the drug was used concomitantly with contraindicated drugs. This study sought to analyze electrocardiograms (ECGs) from a multicenter pediatric study and to identify abnormalities in QTc interval associated with cisapride use.


METHODS
Children between 6 months and 4 years of age were enrolled if they manifested symptoms of gastroesophageal reflux not responding to medical therapy for at least 6 weeks. In 49 subjects, ECGs obtained before and after randomization to receive 0.2 mg/kg dose three times daily or placebo were reviewed independently and blindly by two pediatric cardiologists. Placebo and active drug groups were compared for QTc and for change in QTc from baseline values after 3 to 8 weeks of treatment.


RESULTS
Mean QTc among patients taking the drug was 408+/-18 ms. None was higher than 450 ms. Change between baseline and subsequent QTc at 3 to 8 weeks of treatment was 2+/-20 ms.


CONCLUSIONS
In our study group of children without underlying cardiac disease or electrolyte imbalance, cisapride was found to have no significant effect on cardiac electrical function compared with placebo. These results are consistent with the drug's record of exceedingly infrequent cardiac events. Because the availability of this prokinetic is threatened, its safety and the safety and efficacy of alternative treatment options (including surgery) should be studied further.
Levy
J
J
Babies and Children's Hospital of New York, Columbia University College of Physicians and Surgeons, New York 10032-3784, USA.
Hayes
C
C
Kern
J
J
Harris
J
J
Flores
A
A
Hyams
J
J
Murray
R
R
Tolia
V
V
D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D002675:Child, Preschool; D020117:Cisapride / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006321:Heart / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D010919:Placebos; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
D005765:Gastrointestinal Agents; D010919:Placebos; D020117:Cisapride