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Should cisapride have been “blacklisted”?
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  1. M MARKIEWICZ
  1. Imperial College School of Medicine at Chelsea & Westminster Hospital, 369 Falham Road, London SW10 9NH
  2. AZ-VUB
  3. Department of Paediatrics
  4. Laarbeeklaan 101
  5. 1090 Brussels
  6. Belgium
  1. Y VANDEN PLAS
  1. Imperial College School of Medicine at Chelsea & Westminster Hospital, 369 Falham Road, London SW10 9NH
  2. AZ-VUB
  3. Department of Paediatrics
  4. Laarbeeklaan 101
  5. 1090 Brussels
  6. Belgium

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The recent decision by the Committee on the Safety of Medicine effectively to “blacklist” cisapride for use in neonates has led to considerable debate. The following is intended as a contribution to that debate.

Indications for the use of cisapride

In mild gastro-eosophageal reflux disease (GORD) parental reassurance and dietary manipulation is the most appropriate course of action. In moderate or severe GORD, when medication is thought to be necessary, cisapride is considered to be the most appropriate drug.1 Although it is recognised that cisapride does not consistently show an improvement in all the parameters measured, it consistently shows improvement in at least some of them, most of the time.2 Lack of similar data for the efficacy of domperidone, metoclopramide, and erythromycin precludes their use as first line agents for GORD.3 Published findings on the efficacy of cisapride in the treatment of motility related gastrointestinal disorders in premature infants is not entirely clear.2 3 The impending studies of cisapride in the USA should clarify the issue. Cisapride is useful in several other conditions, such as chronic respiratory disease caused by GORD, oesophagitis, functional dyspepsia and postoperative ileus.2 3

Risks associated with cisapride

Cisapride is known to prolong the QTc interval.3-5 At therapeutic doses in children, however, there is no direct association between serum concentrations and QTc prolongation. Even in overdose situations the drug has a …

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