Cisapride: the problem of the heart

Cisapride has been used in the neonatal population as a first-line gastrointestinal prokinetic agent for managing feeding intolerance secondary to decreased gastrointestinal motility. Cisapride acts specifically at many levels of the gastrointestinal tract and has no central nervous system side effects. Recently, prolonged QT interval has been reported secondary to high-dose cisapride, and concerns regarding its use in premature infants have been raised. In response, Janssen-Ortho Inc. and Janssen Pharmaceutica, the manufacturers of cisapride in Canada and the U.S., have released safety information prohibiting the use of cisapride in premature infants. In light of the present evidence, it is imperative that NICUs that continue to prescribe cisapride for the management of feeding intolerance exercise vigilance in cardiac monitoring and recognize the importance of drug interactions that lead to elevated cisapride levels.