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Gastroenterology (Expert Forum)
Long-term use of Cisapride
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Long-term use of Cisapride
by Peter__0__0, May 19, 1998 12:00AM
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’s treatment must be individualized. It is best to try to obtain relief with the least amount of medications and the lowest dose needed to control symptoms. It is also important not to forget dietary and lifestyle modifications. Your doctor can provide you with a list of anti-reflux measures. 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 would like 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, prilosec, cisapride
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’s treatment must be individualized. It is best to try to obtain relief with the least amount of medications and the lowest dose needed to control symptoms. It is also important not to forget dietary and lifestyle modifications. Your doctor can provide you with a list of anti-reflux measures. 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 would like 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, prilosec, cisapride
Doctor's Answer
