Efficacy and Tolerability of Cisapride in Children

Abstract

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.

Cisapride Use in Pediatric Patients With Intestinal Failure and Its Impact on Progression of Enteral Nutrition

“…It is a selective serotonin 5‐HT 4 receptor agonist that belongs to a group of substitute benzamides. The mechanism of action may be explained by the enhancement of physiologic release of acetylcholine at the level of the myenteric plexus (13). Cisapride has been used to treat GI conditions in children including gastroesophageal reflux disease, esophageal acid exposure in children with cystic fibrosis, functional dyspepsia, constipation, postoperative ileus or delayed orocecal transit and chronic intestinal pseudo‐obstruction (14).…”

Gastric Function in Children with Oesophageal Atresia and Tracheoesophageal Fistula

“…Tegaserod has a similar mechanism by being a 5-HT 4 receptor agonist. However, both cisapride and tegaserod presented significant side effects, mainly cardiac, leading to a withdrawl of their use (43, 44). …”

Gastro-oesophageal Reflux, Some Data on Diagnosis and Clinical Evaluation

“…It was soon noticed that this resulted in the increase in reflux (1), compared to the placement of children in the 30th grade. But it has been seen that the use of this overturning position is not without consequences and should be carefully applied according to a study (2) that the use of this position should be recognized as a treatment that has side effects associated with drug therapy. In a study (3) that sees the SIDS connection with the position, it is not recommended to use lateral positioners and that the child should be placed in the back position.…”