Cisapride Capsule

Cisapride Capsules
Usage
Cisapride capsules are used to improve gastrointestinal motility in certain disorders where delayed gastric emptying or impaired gastrointestinal movement is present. Cisapride is a prokinetic agent that enhances the movement of food through the digestive tract.
It may be prescribed for conditions such as:
• Gastroesophageal reflux disease (GERD) that has not responded adequately to other treatments
• Gastroparesis, particularly when associated with diabetes or other motility disorders
• Chronic gastrointestinal motility disorders
• Certain cases of functional dyspepsia
In many regions, cisapride is available only through restricted or specialist prescribing due to potential cardiac risks. Compounded cisapride capsules may be prepared when individualised dosing is required, under appropriate medical supervision.

Dosage
The dosage of cisapride should be determined by the prescribing practitioner based on the patient’s condition, age, and clinical response.
Typical dosing considerations may include:
• Administered several times daily before meals and at bedtime to enhance gastrointestinal motility.
• Capsules are usually taken 15–30 minutes before meals.
• Dosage adjustments may be necessary depending on therapeutic response and patient tolerance.
Patients should follow the prescriber’s instructions carefully and should not exceed the recommended dose.

Mechanisms of Action
Cisapride is a prokinetic agent that enhances gastrointestinal motility by stimulating the release of acetylcholine in the enteric nervous system.
Its mechanisms include:
Serotonin receptor activity
Cisapride acts primarily as a 5-HT₄ (serotonin) receptor agonist, which increases acetylcholine release from enteric neurons.
Enhanced gastrointestinal motility
The increased acetylcholine stimulates smooth muscle contraction in the gastrointestinal tract, improving gastric emptying and intestinal transit.
Improved lower oesophageal sphincter tone
Cisapride can increase the tone of the lower oesophageal sphincter, which may help reduce symptoms of reflux.

Contraindications
Cisapride should not be used in patients with:
• Known hypersensitivity to cisapride
• History of cardiac arrhythmias, particularly QT interval prolongation
• Congenital long QT syndrome
• Significant electrolyte disturbances (such as hypokalaemia or hypomagnesaemia)
• Concomitant use of medicines known to prolong the QT interval or strongly inhibit cisapride metabolism
It is also contraindicated in patients with gastrointestinal bleeding, obstruction, or perforation, where increased motility may be harmful.

Precautions
Cisapride should be used with caution in patients with:
• Underlying heart disease
• Electrolyte abnormalities
• Liver impairment, which may affect drug metabolism
• Patients taking medications that interact with CYP3A4 enzymes
Other considerations include:
• Cardiac monitoring may be required in some patients due to the potential risk of serious cardiac arrhythmias.
• The medicine should be prescribed only when the benefits outweigh potential risks.
• Patients should seek medical advice if they experience palpitations, dizziness, fainting, or irregular heartbeat.

Storage
• Store below 25°C unless otherwise directed.
• Keep capsules in a tightly closed container.
• Protect from excess heat, moisture, and direct light.
• Keep out of reach of children and pets.
Patients should follow the specific storage instructions on the dispensing label provided by the pharmacy.