[Effects of cisapride on QT interval in children]

Amalia Tamariz-Martel Moreno1, Antonio Baño Rodrigo, Marciano Sánchez Bayle

  • 1Sección de Cardiología Pediátrica. Hospital Universitario Niño Jesús. Universidad Autónoma de Madrid. Madrid. Spain. amtamariz@yahoo.es

Insights

Cisapride treatment did not significantly prolong the corrected QT interval (QTc) in infants and children without risk factors. This study found no significant QTc changes in pediatric patients receiving cisapride.

Area of Science:

  • Pediatric Cardiology
  • Clinical Pharmacology

Background:

  • Gastrointestinal motility disorders are common in infants and children.
  • Cisapride is a prokinetic agent used to treat such conditions.
  • Concerns exist regarding potential cardiac side effects, specifically QT interval prolongation.

Purpose of the Study:

  • To prospectively evaluate the effects of cisapride on the corrected QT interval (QTc) in pediatric patients.
  • To determine if therapeutic doses of cisapride prolong QTc in infants and children.

Main Methods:

  • A prospective study involving 175 children aged 1.5 months to 16.8 years.
  • Electrocardiograms (ECGs) were obtained before and after 15 days of cisapride treatment (0.2 mg/kg/dose, 3-4 times/day).
  • A subset of 24 patients also had a posttreatment ECG.

Main Results:

  • No statistically significant difference was observed in the mean QTc interval before (0.390 ± 0.018 s) and after cisapride treatment (0.391 ± 0.018 s).
  • The mean QTc interval in patients with only a posttreatment ECG was 0.399 ± 0.018 s.
  • No patient exhibited a QTc interval exceeding 0.450 s.

Conclusions:

  • Therapeutic doses of cisapride do not appear to significantly prolong the QTc interval in infants and children.
  • In the absence of associated risk factors, cisapride can be used with a low risk of QTc prolongation in pediatric populations.
  • Further monitoring may be warranted in children with pre-existing cardiac risk factors.

Related Concept Videos

Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists01:23

Drugs Affecting GI Tract Motility: Serotonin Receptor Agonists

Serotonin, a crucial neurotransmitter synthesized by enterochromaffin cells, plays a cardinal role in regulating gastrointestinal (GI) motility. With over 90% of the body's total serotonin in the GI tract, its influence on digestive processes is profound. Serotonin is swiftly released upon various stimuli, such as food boluses or certain drugs, triggering intrinsic sensory neurons in the myenteric plexus and extrinsic vagal and spinal sensory neurons. This leads to the activation of the...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists

5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance01:23

Nonlinear Pharmacokinetics: Dependence of Elimination Half-Life and Dose Clearance

The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
A study on guinea pigs examined the...
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight, compared...
Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers01:20

Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers

Class IV antiarrhythmic drugs, such as verapamil and diltiazem, block calcium channels. They primarily affect the heart, slowing the conduction in calcium-dependent tissues like the SA and AV nodes. These drugs manage reentrant supraventricular tachycardia (SVT) and reduce ventricular rate in atrial flutter/fibrillation.
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...