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Drug interaction between mosapride and erythromycin without electrocardiographic changes

Takao Katoh1, Hirokazu Saitoh, Norihiko Ohno

  • 1The First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.

Japanese Heart Journal
|April 30, 2003
PubMed

Insights

Mosapride coadministration with erythromycin, a CYP3A4 inhibitor, did not prolong the QT interval. This study suggests a reduced risk of cardiac adverse events like torsades de pointes when these drugs are used together.

Area of Science:

  • Pharmacology
  • Clinical Pharmacology
  • Drug Interactions

Background:

  • Cisapride is known to cause QT prolongation and torsades de pointes, potentially via potassium channel blockade.
  • Drug interactions with cytochrome P450 CYP3A4 inhibitors (e.g., macrolides, azoles) are a suspected mechanism for adverse cardiac events.

Purpose of the Study:

  • To investigate the effects of mosapride on electrocardiogram (ECG) parameters and pharmacokinetics.
  • To assess potential cardiac risks when mosapride is coadministered with erythromycin, a CYP3A4 inhibitor.

Main Methods:

  • Ten healthy male volunteers received mosapride (15 mg/day) for 7 days.
  • Mosapride was then coadministered with erythromycin (1200 mg/day) for 7 days.
  • ECG parameters (QT interval, QTc) and mosapride plasma concentrations were monitored.

Main Results:

  • Erythromycin increased mosapride Cmax by 1.6-fold and prolonged its half-life (t1/2) from 1.6 to 2.4 hours, indicating inhibited metabolism.
  • No significant differences were observed in QT interval or QTc between mosapride alone and with erythromycin.
  • No correlation was found between ECG parameters and plasma mosapride concentrations; QTc remained within normal limits.

Conclusions:

  • Mosapride and erythromycin exhibit pharmacokinetic interaction due to CYP3A4 inhibition.
  • Coadministration of mosapride and erythromycin did not significantly affect ECG parameters.
  • The risk of severe clinical adverse events, such as QT prolongation and torsades de pointes, appears low with this drug combination.

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