Re: propulsid or no propulsid?????

Posted By HFHSM.D.-ym on November 10, 1998 at 09:57:16:

In Reply to: propulsid or no propulsid????? posted by tracey on November 10, 1998 at 09:14:20:






I was dx with Gerd in august-  I am unable to tolerate meds such as prilosec and prevacid-also meds like zantc and axcid etc. I have rare side effects and cannot take them either.  I have had all the GH tests, ph monitor showed acid in the esoph at 1.8-3.0.  I have serve chest pain constantly that radiates to my shoulder blade and left arm.  I have had a complete cardiac workup(echo, stress test, holtor monitor etc) at Bostons Massachusetts General hospital.  Everything was fine with these tests except that I have a "patentforamenovale" or  type of murmur.  My GI doctor has me on Zantac at 300mgs and carafate for the time being, I have side effects from the Zantac also(low backache, fatique, dizziness)
He would like me to take Propulsid to help gastic emptying so that the acid does not sit in the esoph so long.  I have refused to take this medication because of FDA warnings-I also take Klonopin at a low dose .75mgs and sometimes  I am on an antidepressant(SSRI) for panic attacks.
I am very afraid of the side effects of the Propulsid (my father died of a heart attack at the age of 34)  My GI doc thinks that I will feel considerably better  with this med.  My chest pain is so severe that I end up in tears most days.  I am scheduled to see a surgeon for the Nissen operation on December 3rd.  Do you think I am crazy not to try the propulsid first?  I am headed no where but to surgery.  But even if I try it it does not "fix" the problem right?  Once off the propulsid I will have the same problem correct?  Please help lead me in the right direction.  Sorry this post is so long I have gone through 2 years of agony and want this to end.  Your reply would be appreciated.
Dear Tracey,
I appreciate your dilemma. Cisapride (Propulsid) can be very useful in the treatment of gastroesophageal reflux disease (GERD), in particular, in patients with abdominal bloating and nausea as part of the clinical symptoms of GERD. As you mentioned, it accelerates gastric emptying, but it also tightens the lower esophageal sphincter. Most patients on this drug do well. Some will have diarrhea. Patients with underlying heart disease and arrhythmias should not take this drug. The major drawback to taking this drug is its drug interactions. Patients on certain antibiotics,. certain antihistamines and anti-fungal drugs can develop fatal cardiac arrhythmias if they take those medications with cisapride (Propulsid). Given your history of poorly tolerating a variety of medications used to treat gastroesophageal reflux disease, I understand your hesitation in trying a new drug. The indications for surgery in the treatment of gastroesophageal reflux disease include refractoriness to medical therapy, inability to tolerate medical therapy or youngs patients who do not wish to continue on long-term medical therapy. I do believe that you should have a surgical consultation at this time whether or not you decide to go ahead with it. This will provide you with another perspective and give you another option for management, so that you can make better, informed decisions. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you wish to be seen at our institution please call 1-800-653-6568, our Referring Physicians Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: gastroesophageal reflux disease, cisapride, surgery