Cisapride Suspension

Cisapride Suspension
Usage
Cisapride suspension is an oral liquid formulation used to improve gastrointestinal motility in selected patients with disorders of delayed gastric emptying or impaired gastrointestinal transit. It is a prokinetic agent that enhances movement of food through the digestive tract.
It may be prescribed for:
• Gastroesophageal reflux disease (GERD) not adequately controlled by other therapies
• Gastroparesis, including diabetic gastroparesis
• Chronic gastrointestinal motility disorders
• Certain cases of functional dyspepsia
Due to potential cardiac safety concerns (QT prolongation and arrhythmias), cisapride is generally used under specialist supervision and may be subject to restricted access.

Dosage
Dosage should be determined by the prescribing practitioner based on the patient’s age, weight, condition, and clinical response.
Typical dosing considerations include:
• Administered multiple times daily, often before meals and at bedtime
• The suspension should be shaken well before use
• Usually taken 15–30 minutes before meals to optimise prokinetic effects
• Dosage adjustments may be required in patients with hepatic impairment
Patients should follow the prescribed dosing schedule carefully and should not exceed the recommended dose.

Mechanisms of Action
Cisapride is a serotonin (5-HT₄) receptor agonist that enhances gastrointestinal motility.
Its mechanisms include:
Stimulation of 5-HT₄ receptors
Cisapride activates serotonin receptors in the enteric nervous system.
Increased acetylcholine release
This leads to enhanced release of acetylcholine, a neurotransmitter that promotes smooth muscle contraction.
Improved gastrointestinal motility
Increased smooth muscle activity results in improved gastric emptying and intestinal transit.
Increased lower oesophageal sphincter tone
This may help reduce reflux symptoms in some patients.

Contraindications
Cisapride should not be used in patients with:
• Hypersensitivity to cisapride or any component of the formulation
• History of QT prolongation or serious cardiac arrhythmias
• Congenital long QT syndrome
• Electrolyte disturbances (e.g., hypokalaemia, hypomagnesaemia)
• Concurrent use of medicines that prolong the QT interval or inhibit cisapride metabolism (e.g., strong CYP3A4 inhibitors)
• Gastrointestinal obstruction, perforation, or bleeding

Precautions
Cisapride should be used with caution in patients with:
• Cardiovascular disease
• Hepatic impairment
• Electrolyte imbalances
• Patients taking medications that affect CYP3A4 metabolism
Additional considerations include:
• Risk of serious cardiac arrhythmias, including torsades de pointes
• Careful patient selection and monitoring may be required
• Avoid exceeding prescribed doses to minimise risk
• Patients should be advised to report symptoms such as palpitations, dizziness, fainting, or irregular heartbeat
Use should be limited to situations where the benefits outweigh the potential risks.

Storage
• Store below 25°C unless otherwise directed
• Keep the suspension in a tightly closed container
• Shake well before use
• Protect from heat, moisture, and direct light
• Some compounded formulations may require refrigeration, depending on preparation
• Keep out of reach of children and pets
Patients should follow the specific storage instructions provided on the dispensing label supplied by the pharmacy.