A Double Blind Placebo Controlled Study on Prophylactic Use of Cisapride on Feed Intolerance and Gastric Emptying in Preterm Neonates

Reddy, P. Narsimha; Deorari, A. K.; Bal, Chandra Shekhar; Paul, VK; Singh, Manmohan

doi:10.1203/00006450-199904020-01722

Cited by 13 publications

(22 citation statements)

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“…Four placebocontrolled trials in premature infants with feeding intolerance and GORD have been published. [10][11][12][13][14] In 2 of these trials, cisapride was no more effective than placebo in improving feeding tolerance, gastric emptying and bodyweight gain. [10,11] In a third study, milk tolerance and gastric emptying increased, and vomiting decreased significantly with cisapride.…”

Section: Cisapride and Treatment Of Gastrointestinal Diseasementioning

confidence: 93%

Efficacy and Tolerability of Cisapride in Children

Vandenplas¹,

Benatar²,

Cools³

et al. 2001

Paediatric Drugs

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As gastro-oesophageal reflux disease (GORD) in infants and children is a motility disorder which differs in pathophysiology and clinical course from GORD in adults, prokinetics should be considered the drug of choice in certain circumstances. Indeed, cisapride may result in improvement of feeding tolerance in premature infants. Cisapride has a better tolerability profile than a 'wait-and-see-if-improvement-comes-spontaneously' policy or the other therapeutic options available. A careful and critical review of published data suggests that cisapride may have a QTc-prolonging effect. However, provided the precautions for cisapride administration are followed, the QTc-prolonging effect remains consistently without clinically relevant adverse effects. Correct dosage and avoidance of concurrent treatment with macrolides and/or azoles are the most relevant tolerability recommendations in children. Although there is a need for a prokinetic with better efficacy, cisapride is currently the prokinetic with the best benefit-to-risk ratio available. Thus, withdrawal of cisapride would result in a significantly increased risk for severe complications in infants and children with GORD or other gastrointestinal motility disorders such as chronic intestinal pseudo-obstruction, gastroparesis and feed intolerance in premature infants.

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Section: Cisapride and Treatment Of Gastrointestinal Diseasementioning

confidence: 93%

Efficacy and Tolerability of Cisapride in Children

Vandenplas¹,

Benatar²,

Cools³

et al. 2001

Paediatric Drugs

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show abstract

“…However a Cochrane Review has recently stated that there is no clear evidence that cisapride reduces symptoms of GOR (26). Studies done in Australia and India have also found no benefit of cisapride in reducing feed intolerance in premature neonates (27,28).…”

Section: Cisapride For Gastro-oesophageal Refluxmentioning

confidence: 99%

“…This may expose the patient to increased risk of medicine toxicity and adverse events, e.g. chronic use of amphetamines and methylphenidate to treat ADHD carries the possible risk for cardiovascular events such as myocardial infarction, stroke and sudden death later in life (27). …”

Section: Post-marketing Monitoring Of Medicine Safety For Medicines Amentioning

confidence: 99%

Untitled

2016

IJPSR

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“…Cisapride is the most well known agent in this class, and has dual stimulatory effects on the 5-Hydroxytryptamine (5-HT4) serotonin receptors and the parasympathetic nervous system, leading to increases in both 5-HT4 and acetylcholine in the enteric nervous system. The use of cisapride has been shown to associate with improved gastric emptying in critically ill patients as well as reduced the occurrence of feed intolerance [38][39][40][41][42] . Due to case reports of cisapride induced lethal cardiac toxicity [43] , however, the drug has been withdrawn and is not available for clinical use.…”

Section: Serotonin (5-hydroxytryptamine) Receptor Agonistsmentioning

confidence: 99%

Pharmacological therapy of feed intolerance in the critically ills

Nguyen¹

2014

WJGPT

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Feed intolerance in the setting of critical illness is associated with higher morbidity and mortality, and thus requires promptly and effective treatment. Prokinetic agents are currently considered as the first-line therapy given issues relating to parenteral nutrition and postpyloric placement. Currently, the agents of choice are erythromycin and metoclopramide, either alone or in combination, which are highly effective with relatively low incidence of cardiac, hemodynamic or neurological adverse effects. Diarrhea, however, can occur in up to 49% of patients who are treated with the dual prokinetic therapy, which is not associated with Clostridium difficile infection and settled soon after the cessation of the drugs. Hence, the use of prokinetic therapy over a long period or for prophylactic purpose must be avoided, and the indication for ongoing use of the drug(s) must be reviewed frequently. Second line therapy, such as total parenteral nutrition and post-pyloric feeding, must be considered once adverse effects relating the prokinetic therapy develop.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Adverse effects; Critical illness; Enteral feeding; Feed intolerance; Prokinetic therapyCore tip: Feed intolerance during critical illness must be promptly recognized and treated due to the associated morbidity and mortality. The current first line treatment for feed intolerance is prokinetic therapy with erythromycin and metoclopramide (alone or in combination), which are highly effective and free of significant adverse effects. Although diarrhoea occurs commonly after combination prokinetic therapy, it is not associated with Clostridium difficile colitis and settled shortly after stopping the treatment. The use of prokinetic therapy over a long period or for prophylactic purpose, therefore, must be avoided and the indication for ongoing use of the drug(s) should be frequently reviewed.Nguyen NQ. Pharmacological therapy of feed intolerance in the critically ills.

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A Double Blind Placebo Controlled Study on Prophylactic Use of Cisapride on Feed Intolerance and Gastric Emptying in Preterm Neonates

Cited by 13 publications

References 0 publications

Efficacy and Tolerability of Cisapride in Children

Efficacy and Tolerability of Cisapride in Children

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Pharmacological therapy of feed intolerance in the critically ills

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