Is rectally administered cisapride an effective prokinetic agent?

OBJECTIVE: To summarize the published data on the efficacy of rectally admi nistered cisapride. DATA SOURCES: Published double-blind, placebo-controlled trials on rectally administered cisapride identified by MEDLINE (January 1966-December 1998) and International Pharmaceutical Abstracts (January 1970-December 1998) sea rches. DATA SYNTHESIS: Cisapride is an oral prokinetic agent that increases lower esophageal sphincter tone, accelerates gastric emptying, and increases smal l-bowel motility. Clinical trials of rectal cisapride have used both single - and multiple-dosing regimens. Typically, patients received one or two 30- mg suppositories (provided by the manufacturer). Rectal cisapride was effec tive in enhancing gastric emptying of solid or semisolid meals in healthy p atients or patients with chronic gastric emptying disorders. Rectal cisapri de was not effective in antagonizing the gastrointestinal effects of narcot ic analgesics or promoting the return of small-bowel activity in adults wit h postoperative ileus. Mixed results were seen when rectal cisapride was us ed to promote enteral feedings in patients with persistent ileus, CONCLUSIONS: The use of rectal cisapride cannot be recommended at this time . Rectal cisapride was effective only in patients who could have otherwise taken either cisapride tablets or suspension but it was not effective in pa tients who are physically unable to swallow or restricted from ingesting an ything orally following surgical procedures. Considering the varied patient populations and evaluation methods used in these studies, the lack of a co mmercially available cisapride suppository, and absence of studies involvin g extemporaneously prepared cisapride suppositories, the use of suppositori es should be limited to investigational trials.