Motility Disorder

  What is the difference between Propulsid and Domperidone when treating slow gastric emptying?
  I realize that Propulsid is a "newer" drug, but the FDA has recently warned about more severe side effects mainly having to do with the heart.
  Does Domperidone have similar side effects?
  Thank you.
Dear Mary,
Cisapride (Propulsid) acts mainly by promoting the release of the neurotransmitter acetylcholine at the myenteric plexus (nerves innervating the smooth muscle of the esophagus), thereby increasing lower esophageal sphincter pressure, improving forward motion down the esophagus (peristalsis) and accelerating stomach emptying. Studies have shown that cisapride can heal esophageal inflammation. Side effects are minimal and include headaches, abdominal cramping and diarrhea. In patients who are on a variety of antibiotics, antifungal drugs and anti-histamines with cisapride abnormal heart rhythms can occur. Abnormal heart rhythms and palpitations can also occur in patients with underlying heart disease. Cisapride should not be used in these patients.
Domperidone is not yet available in the United States but I was told by the pharmaceutical company that it will be marketed soon under the name Motilium. It is a drug very much like metoclopramide (Reglan) but it does not have as many side effects. It is a peripheral dopamine antagonist. Domperidone increases lower esophageal sphincter pressure and also accelerates gastric emptying. I have only a handful of patients taking this drug (they get it from Canada) and they seem to tolerate the drug without side effects. We have to wait till domperidone is more widely available in the United States before we can be more sure about its side effect profile. I hope you find this information helpful.
HFHSM.D.-ym
*Keywords: cisapride, domperidone

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