Alternatives to cisapride

Abstract

Cisapride has the potential to cause arrhythmias, particularly in susceptible patients, at higher doses and when combined with drugs or foods that inhibit its metabolism. Meta-analyses suggest that the efficacy of cisapride may have been overestimated in the past. Many currently available medications have equivalent or greater efficacy than cisapride for indications such as gastro-oesophageal reflux disease, functional dyspepsia, oesophageal dysmotility and constipation. The alternatives include acid suppressing drugs, domperidone, metoclopramide and laxatives. Several drugs currently under development, especially the new 5HT4 agonists and GABA-B agonists, may also be of value. Cisapride still has a limited role in gastroparesis.