Cisapride Gel

Cisapride Gel
Usage
Cisapride gel is a compounded topical formulation used in selected clinical settings where localised prokinetic or smooth muscle–modulating effects are desired. While cisapride is primarily known as an oral gastrointestinal prokinetic agent, topical formulations may be considered for specialist-directed use when alternative routes are required.
Potential uses may include:
• Transdermal administration in patients unable to tolerate oral formulations
• Situations requiring individualised dosing or alternative delivery routes
• Veterinary or specialist applications where oral therapy is not feasible
Due to known cardiac safety concerns associated with cisapride, use should be restricted to carefully selected patients under specialist supervision.

Dosage
Dosage and frequency of application should be determined by the prescribing practitioner based on the patient’s condition and therapeutic requirements.
Typical considerations include:
• Apply a measured amount of gel to clean, intact skin, usually once or twice daily, or as directed
• Apply to areas suitable for transdermal absorption (e.g., inner wrist or other recommended sites)
• Hands should be washed after application
• Avoid contact with eyes, mucous membranes, or broken skin
Patients should follow the specific instructions provided by their healthcare provider.

Mechanisms of Action
Cisapride is a prokinetic agent that enhances gastrointestinal motility through serotonergic mechanisms.
Its mechanisms include:
5-HT₄ receptor agonism
Cisapride stimulates serotonin (5-HT₄) receptors in the enteric nervous system.
Increased acetylcholine release
Activation of these receptors enhances the release of acetylcholine, which promotes smooth muscle contraction.
Enhanced gastrointestinal motility
This results in improved gastric emptying and intestinal transit.
In topical/transdermal use, cisapride is absorbed through the skin and exerts systemic prokinetic effects.

Contraindications
Cisapride gel should not be used in patients with:
• Hypersensitivity to cisapride or formulation components
• History of QT prolongation or cardiac arrhythmias
• Congenital long QT syndrome
• Concurrent use of medications that prolong the QT interval or inhibit cisapride metabolism
• Gastrointestinal obstruction, perforation, or bleeding

Precautions
Cisapride gel should be used with caution in patients with:
• Cardiovascular disease
• Electrolyte imbalances (e.g., hypokalaemia, hypomagnesaemia)
• Hepatic impairment
• Patients taking medications affecting CYP3A4 metabolism
Additional precautions include:
• Due to the risk of serious cardiac arrhythmias, careful patient selection and monitoring may be required
• Avoid excessive application to reduce risk of systemic toxicity
• Patients should be advised to report symptoms such as palpitations, dizziness, or fainting
Use should be limited to situations where benefits outweigh potential risks.

Storage
• Store below 25°C unless otherwise directed
• Keep the container tightly closed when not in use
• Protect from heat, moisture, and direct light
• Do not freeze unless specifically instructed
• Keep out of reach of children and pets
Patients should follow the specific storage instructions provided on the dispensing label supplied by the pharmacy.