Neonatal Intensive Care UnitChildren's Hospital


Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



  • symptomatic management of gastrointestinal (gi) motility disorders which include gastroesophageal reflux disease, gastroparesis and intestinal pseudo-obstruction.


  • cisapride is a gastrokinetic drug that increases esophageal peristaltic activity and lower esophageal sphincter tone.
  • gastric and duodenal contractility and emptying are increased.
  • both small and large bowel transit is improved.
  • cisapride is believed to act by increasing the release of acetylcholine at nerve endings in the myenteric plexus of the GI tract; it does not possess dopamine antagonist activity.
  • cisapride differs from 2 other gastrokinetic drugs, domperidone and metoclopramide, in the following:
    1. cisapride enhances motility in both the upper and lower sections of the GI tract
    2. cisapride lacks anti-emetic properties
    3. cisapride does not increase serum prolactin concentration
    4. cisapride does not appear to possess the CNS side effects and extrapyramidal reactions which result from dopamine antagonism
  • because of the "first-pass" effect in the liver, and gut wall, only 40 to 50% of an oral dose reaches the systemic circulation.
  • extensively metabolized in the liver; metabolites are eliminated in urine and feces.
  • very highly (98%) protein bound, mainly to albumin.

Adverse Effects

  • GI mostly - diarrhea, borborygmi (rumbling noise caused by the propulsion of gas through the intestines) transient abdominal cramping, abdominal distension, flatulence
  • small incidence (< 2%) of somnolence, drowsiness, lethargy, fatigue


  • NOTE: In July of 1997 Janssen - Ortho Inc (Canada) issued a letter stating "Prepulsid is contraindicated in prematurely born infants (born at a gestational age of less than 36 weeks), from 0 through three months after the delivery date."(128)

    This follows case reports of prolongation of the QT interval in infants and pediatric patients. (129 - 132) In addition, a prospective study of 49 neonates demonstrated an increased QT interval (above an arbitrary interval of 0.45, n=7). (133) The prolonged QT interval was inversely correlated to birth weight and gestational age and was most frequent in infants < 33 weeks gestation.

  • cisapride is contraindicated in conditions where stimulation of the GI tract may be dangerous (eg. gastrointestinal hemorrhage, mechanical obstruction or perforation, Hirschsprung's disease, or following an episode of necrotizing enterocolitis)


  • initial dosage should be reduced in hepatic or renal insufficiency


  • 0.2 mg/kg po tid-qid
  • administer 15 min before feeds


  • 1 mg/mL suspension


  1. Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
  2. Verlinden M and Wellburn P: The use of prokinetic agents in the treatment of gastrointestinal motility disorders in childhood, in Disorders of Gastrointestinal Motility in Childhood, Milla PJ (Ed), John Wiley and Sons Ltd, p 125-140,1988.
  3. Vandenplas Y, Deneyer M, Verlinden M et al: Gastroesophageal reflux incidence and respiratory dysfunction during sleep in infants, Journal of Pediatric Gastroenterology and Nutrition 1989: 8:31-36.
  4. Murdoch J: Cisapride, Pharmacy Practice 1990 (June): 23-25.
  5. Raoult A (Vice-President, Scientific Affairs, Janssen-Ortho Inc, Canada), Letter to Healthcare Professionals, July 22, 1997.
  6. Lewin MB, Bryant RM, Fenrich AL et al : Cisapride-induced long QT interval. The Journal of Pediatrics 1996; 128: 279-81.
  7. Bedu A, Lupoglazoff JM, Faure C et al : Cisapride high dosage and long QT interval (Letter). The Journal of Pediatrics 1997; 130: 164.
  8. Hanson R, Browne G, Fasher B et al : Cisapride-induced prolonged QT interval:too much of a good thing (Letter). The Journal of Pediatrics 1997; 130 : 164-166.
  9. Vervaet et al. Unpublished data base of Janssen-Ortho Inc. November 1996.
  10. Bernardini S, Semama DS, Huet F et al: Effects of cisapride on QTc interval in neonates. Archives of Disease in Childhood (Fetal Neonatal Edition)1997; 77(3) : F 241-3


Last Updated: 1 November 1999

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