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Cisapride-induced torsades de pointes

J Vitola1, J Vukanovic, D M Roden

  • 1Vanderbilt University School of Medicine, Department of Medicine, Nashville, Tennessee 37232-6602, USA.

Journal of Cardiovascular Electrophysiology
|November 17, 1998
PubMed
Summary

Two cases of torsades de pointes linked to cisapride are presented. Drug accumulation, due to interactions inhibiting cisapride metabolism, predictably caused these serious cardiac arrhythmias.

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Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Cardiology

Background:

  • Cisapride is a gastroprokinetic agent.
  • Drug-drug interactions can alter drug metabolism and levels.
  • Torsades de pointes is a potentially life-threatening arrhythmia.

Observation:

  • Two patients developed torsades de pointes while taking cisapride.
  • Both patients were also on medications known to inhibit cisapride metabolism.
  • In one case, elevated cisapride levels were detected after the event.

Findings:

  • Concomitant drug therapy inhibiting cisapride biotransformation led to torsades de pointes.
  • Drug accumulation, indicated by elevated plasma cisapride, played a role in causing the arrhythmia.
  • These adverse drug reactions are predictable, not idiosyncratic.

Implications:

  • Healthcare providers should be aware of the risk of cisapride-induced torsades de pointes.
  • Careful consideration of concomitant medications is crucial when prescribing cisapride.
  • Understanding drug metabolism pathways can help predict and prevent serious adverse drug events.

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