Long-term use of Cisapride

  Hello I have been recently diagnosed with GERD and I was initially
  put on pantaloc 40 mg twice a day and cisapride 3-4 times a day.  
  After a month of this I was taken off the above meds and put on
  pepcid 20 mg twice a day.  The symptoms of GERD completely left me
  for about 2 months but they have now come back as bad as ever.  My
  doctor put me on Pantaloc 40 mg once a day which I started today.
  My questions are:
  1. why not put me on the cisapride also?
  2. can I stay on pantaloc for a long time?
  3. can drugs like cisapride and pantaloc be taken to provide
     immediate relief (for a few days) and then discontinued.  In other
     words can I take them only when I seem to need them?
  4. I was initially on pantaloc twice a day.  Is once a day going to do the
     job?
_
Dear Peter,
As you pointed out, the symptoms of gastroesophageal reflux disease (GERD) tend to be chronic and often recur after the discontinuation of medical therapy. I am not familiar with the medication you refer to as Pantaloc. I wonder if it is Prilosec (omeperazole). Omeperazole (Prilosec) is a potent inhibitor of acid secretion.  A dose of 40 mg twice daily is a high dose. A dose of 40 mg once daily or 20 mg twice daily (A dose taken about one half hour before breakfast and dinner)of omeperazole (Prilosec) is also a fairly high dose for the treatment of GERD. Omeperazole (Prilosec) has been used in European patients for the treatment of GERD for several years at a time without major side effects. Omeperazole has been associated with the development of uncommon stomach tumors called carcinoids in rats given very high doses over a long period time. There have not been any documented cases in humans on omeperazole for GERD. In my clinical practice, I start with a dose of 20 mg once or twice daily and if the patient improves over a 3 month period I try to wean the patient off of the medication. When the patient feels better, I will sometimes allow him or her to take the medication intermittently when needed.
You also mentioned cisapride (Propulsid). This is a medication that works by a different mechanism than omeperazole (Prilosec). It helps to more rapidly empty the stomach and helps to tighten the lower esophageal sphincter. In some patients cisapride alone is sufficient to control GERD symptoms. Others find relief  when cisapride and omeperazole are prescribed in combination. Cisapride can cause mild diarrhea but is generally well tolerated. However, in patients with underlying heart disease or in patients who are on certain medications (such as certain antibiotics, antifungal drugs and antihistamines) palpitations and abnormal heart rhythms can occur. Again, once initial control of symptoms is obtained, a lower dose or a trial of medication when needed is sometimes appropriate.
As you can tell from this communication, there is no one right way to treat chronic GERD. Each patient

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