A RISK-BENEFIT ASSESSMENT OF CISAPRIDE IN THE TREATMENT OF GASTROINTESTINAL DISORDERS

Cisapride is a substituted benzamide compound that stimulates motor ac tivity in all segments of the gastrointestinal tract by enhancing the release of acetylcholine from the enteric nervous system. Cisapride is administered orally in the treatment of gastro-oesophageal reflux dis ease, functional dyspepsia, gastroparesis, chronic intestinal pseudo-o bstruction syndromes and chronic constipation. In gastro-oesophageal r eflux disease in both adults and children, cisapride provides symptoma tic improvement and mucosal healing. Long term treatment with cisaprid e is effective in the prevention of relapse of oesophagitis. Cisapride improves gastric emptying rates and improves symptoms in patients wit h gastroparesis of various origins. Unlike domperidone and metoclopram ide, long term administration of cisapride seems to result in persiste ntly enhanced gastric emptying. Cisapride is also effective in improvi ng symptoms in patients with functional dyspepsia. In comparative stud ies in patients with functional dyspepsia, cisapride was at least as e ffective as metoclopramide, domperidone, clebopride, ranitidine and ci metidine. Cisapride increases stool frequency and reduces laxative con sumption in patients with idiopathic constipation. Severe cases of slo w transit constipation seem refractory to cisapride. Clinical studies also indicate that cisapride might be effective in the treatment of ch ronic intestinal pseudo-obstruction, postoperative ileus, peptic ulcer and irritable bowel syndrome. Further clinical studies are warranted to define the role of cisapride in these conditions. The dosage of cis apride ranges from 5mg 3 times daily to 20mg twice daily. Cisapride is generally well tolerated, both during short and long term treatment. In children, cisapride is also well tolerated in doses of 0.2 to 0.3 m g/kg, 3 to 4 times daily. The most frequently reported adverse effects are transient abdominal cramping, borborygmi and diarrhoea. These are an extension of the pharmacological profile of the drug and only rare ly necessitate treatment withdrawal. Rarely, tachycardia and urinary d isorders have been observed during treatment with cisapride. Unlike ma ny other prokinetic agents, cisapride is devoid of central antidopamin ergic and neuroendocrine effects. Hence, cisapride may be better toler ated than metoclopramide and domperidone. The acceleration of gastric emptying by cisapride may affect the absorption and peak plasma concen trations of other drugs.