Cisapride is an orally administered prokinetic agent which facilitates or restores motility throughout the length of the gastrointestinal tract. It is a substituted piperidinyl
benzamide, chemically related to
metoclopramide, but unlike
metoclopramide,
cisapride is largely devoid of central depressant or antidopaminergic effects. In placebo-controlled trials,
cisapride improved healing rates and symptoms in both adults and children with reflux oesophagitis. Maintenance
therapy with
cisapride at half the healing dose is effective in reducing the incidence of relapse. Symptoms are also alleviated in patients with functional
dyspepsia, and gastric emptying and symptoms are improved in most patients with
gastroparesis, an effect which is sustained during long term administration. However, the efficacy of
cisapride in end-stage
gastroparesis remains less clear.
Cisapride increases stool frequency in patients with chronic
constipation, and limited data suggest that the
drug may also be beneficial in treating chronic
intestinal pseudo-obstruction and
irritable bowel syndrome.
Cisapride demonstrated efficacy comparable with or superior to that of
metoclopramide, and was at least as effective as
cimetidine and
ranitidine in patients with reflux disease. In patients with functional
dyspepsia,
cisapride has shown at least equal efficacy to
domperidone,
metoclopramide and
ranitidine, and superior efficacy to
cimetidine in the small comparative trials conducted to date. Adverse effects in patients receiving
cisapride are generally transient and mild, with abdominal cramping, borborygmi, diarrhoea or loose stools most frequently reported. Central nervous system adverse effects are rare. Thus, with its favourable tolerability profile and demonstrated efficacy in a variety of gastrointestinal motility disorders, the position of
cisapride as a valuable agent in the management of patients with gastrointestinal motility disorders is strengthening. However, larger well-controlled comparative trials of the
drug with other agents are necessary before the relative position of
cisapride in
therapy can be categorically defined.