propulsid and heart arrhythmias

[marie50]

I am the mother of a 28 year old with Down’s Syndrome who recently started taking Propulsid for the treatment of gastroparesis that developed after gallbladder surgery. I am very concerned about her use of this drug because of Propulsid’s history of causing serious heart arrhythmias. Although my daughter has no history of heart problems, I worry she may have an unknown heart or biochemical abnormality due to the Down’s that could make her prone to developing arrhythmias while taking this drug. I am also concerned because she is non-verbal and would not be able to tell me if she were experiencing unusual heart rhythms.  Should I have a cardiologist evaluate her if we choose to continue using this medication? Would an EKG reveal any pre-existing condition, other than long QT Syndrome, that would contraindicate the use of this drug? After using the medication for a period of time, would periodic EKGs reveal problems that could be developing? Thank you very much.

[Cleveland Clinic, MD]

Propulsid (generic cisapride) is generally a well tolerated drug with a very low incidence of side effects.  There were less than 1% of patients taking the drug that reported palpitations.  There have been some rare reports of fatal heart arrhythmias in patients taking cisapride although causality has not been established.    Cisapride is metabolized through the cytochrome P-4503A4 system and therfore certain drugs should be avoided to reduce the risk of a dangerous rhythm.  These drugs are:itraconazole, miconazole, clarithromycin, erythromycin, and troleandomycin.

[Tandy]

Thank you for your prompt reply. It is reassuring to know that serious side effects from Propusid are uncommon. I understand that most arrhythmias have been related to interactions between Propulsid and other drugs such as those you mentioned. I was just hoping there could be a way of knowing in advance who might become one of those in the less than 1% who experience side effects.

[Cleveland Clinic, MD]

Unfortunately not.  There are alternative to propusid and I would discuss these with her doctor if this is a concern.