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Published: November 1999

Cisapride and Arrhythmias

Prescriber Update 19: 22–23
November 1999

Medsafe Editorial Team

Cisapride (Prepulsid™) causes QT-prolongation which may worsen to life-threatening torsade de pointes. The WHO database holds 159 reports of these events. Many patients were taking interacting medicines, most commonly erythromycin, fluconazole, clarithromycin and amiodarone. Excessive dose and electrolyte disturbances also featured in the cases.
Cisapride should be avoided with substances which inhibit cytochrome P450 3A4, with other agents which prolong the QT-interval, in patients with predisposing factors for arrhythmia or pre-existing QT-prolongation and in patients with hepatic failure.

Cisapride can cause QT-prolongation

An article published in Prescriber Update in February 1997 advised of the possibility of QT-prolongation with cisapride (Prepulsid™). At that time it was not possible to be confident of the causal association. Since that time further data, including clinical studies, have become available confirming the association.

159 reports of QT-prolongation and/or torsade de pointes in WHO database

At the end of July 1999, the WHO database held 159 reports of QT-prolongation and/or torsade de pointes with cisapride. 82 of these cases involved torsade de pointes. Death was the outcome in 11 cases. In around half of the cases the patient was taking an interacting medicine, most commonly erythromycin, fluconazole, clarithromycin and amiodarone. Excessive dose and electrolyte disturbances were factors in a small number of cases.

Avoid cisapride with interacting medicines or predisposing conditions

Cisapride should be avoided in the following circumstances:

Cardiac arrhythmias and cisapride are an adverse reaction of current concern. Please report all New Zealand cases to the Centre for Adverse Reactions Monitoring, University of Otago, PO Box 913, Dunedin