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Digestive Disorders / Gastroenterology Forum
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Avatar universal

Propulsid

My allergist has suggested that I double my Propulsid dosage to 20 mg 4 times a day for several weeks.  If at the end of that period I am not any better, he will refer me back to the gastroenterologist.  After hearing that Propulsid has been linked to numerous deaths, I am leary of doing this.  What exactly is the story with Propulsid?  Is it safe?  Are these deaths solely from drug interactions?  

Also, in reading the drug insert for Prilosec, I noticed that it is recommended for periods of 4 to 6 weeks.  I've been on 40 mg daily for 2 years.  Is this safe?  What are the long term effects of Prilosec?
30 Responses
Avatar universal
DEar Debbie,
The Food and Drug Administration recently warned that Propulsid has been associated with a number of deaths due to cardiac arrythmias.  For that reason, the FDA suggested that the drug be restricted to patients with severe nocturnal reflux.

Although the risk of a hearty problem is increased if you take propulsid in conjunction with other drugs e.g. certain antibiotics, drugs used in psychiatric conditions, individuals with vomiting, renal disease or electrolyte abnormalities are also at risk.

I suggest that you discuss the use of this medication with your doctor as quickly as possible.
Avatar universal
This sure if a tough one re; the Propulsid.  I did alot of researching on this drug prior to my 17 yr old son taking it.  The literature as well as the dr.'s assured me it was safe and the danger comes in to only those w/ prior cardiac history.

Well I must tell you my son was checked at age 15 for cardiac problems; ekg, halter monitor even echo and everything was perfect.  He went on the Propulsid and landed in the ER x2 with chest pains and shortness of breath.  Since we stopped the drug there has been absolutely no symptomology whatsoever.

I questioned his dr. about it even since he has been off it, and insists it is safe.  Is there not another drug they can try for you.  I am not a dr. but it seems you are going to be taking quite a bit of this drug.  I would check the "net" ask your dr. and pharmacists their feelings on it.  I can see and understand why the dr's like it too; because unlike Reglan it does not effect that I am aware of the Central Nervous System.  Take care and best of luck w/ your difficult decision.  Laura
Avatar universal
Thank you for your response.  I did send my question to Janssen, the manufacturer, and got a telephone response the right away the next morning.  Guess if you ask why their drugs kill people they take it seriously.  :-)  They went through every drug I am presently taking and told me that one of them could cause cardiac arrythmia (not sure I spelled that correctly).  They advised that I not double the dosage until I went back to the doctor with the new drug information sheet and had serum enzyme testing done.  They faxed the sheet to me yesterday morning.  So, I'm off to investigate next week.

Both medications don't seem to help much.  I keep taking them because the internist, the allergist and the gastro guy tell me to.  This GERD stuff is the pits!
Avatar universal
I need some info on prilosec 20mg was taking aciphex 20mg but it was giving me real bad headaches and photosensitivity. So im back on prilosec until i get scoped.With the prilosec i get palpitations and like anxiety. are these normal?
Avatar universal
I posted some comments about Propulsid under the heading "motility disorders", which was posted on December 5.  Basically, I think Propulsid caused premature ventricular contractions.
Avatar universal
Just posted but forgot to mention that testing serum electrolytes might not be adequate.  What is really important is to determine intracellular electrolytes.  But, good luck, on finding anyone to do it.
Avatar universal
It is hard to find a happy medium  in regulating GERD especially when you have side effects to the medications. I have GERD and have tried Prilosec, which gave me anxiety and dizzy spells to the point where I could not stand up and actually passed out twice at work. ( other causes of these symptoms were ruled out ). Within a week of stopping the Prilosec the dizziness, anxiety and passing out feeling went away. I have now tried Aciphex for about 3 weeks. So far, I have not had any side effects that I could not tolerate. Propulsid has hit the news lately with all of the cardiac side effects and  I plan to stay away from that as well. Did you try the low dose of Prilosec ( 10 mg vs the 20 mg ? ) Did you try taking the Prilosec at night instead of in the morning ? The pharmacist had recommeded that initially as well. Have you tried Previcid ?  I hope your scope gives you piece of mind.
Avatar universal
Recent articles related to the extended use of Lansoprazole (Prilosec)ie.beyond 18 months, have shown this drug to be safe.
There are some questions relating to a reduction of e-pylori and the chance for fungal overgrowth, but remains the course of treatment when indicated.

Remember, by increasing the ph.with Prilosec, one must realize the stomach contents have the same dynamic. Symptoms associated with G.E.R.D. are related to several issues. Reducing the quality of acid (ph>6.5) will assist in esophageal healing and will reduce specific symptoms. However the contents of the lower esophagus and stomach remain unchanged; the reflux can continue and may produce many of the same symptoms, many of the same symptoms to a lesser degree or may produce new symptoms.
Avatar universal
Propulsid (Cisapride) has several well documented adverse reactions and they are well described in the product insert.
Among them are warnings of RARE cases of cardiac disrythmias and ventricular disrythmias.

Benefits and risks, these are the key words, benefits and risks.

Propulsid is a Serotonin-4 (5-Ht4) receptor agonist. Whenever a modification is made to the above receptor sites, many actions take place including the desired increase in gastrointestinal motility. This action also includes an increase in electrical activity which produces the vital systolic and diastolic function of the normal heart.Undiagnosed cardiac disrythmias are quite the norm. When that population has further modification to the electrocardiac profile, the symptoms will present themselves.

Depression is a very common symptom associated with G.E.R.D. and for obvious resons. Most of these secondary depressions are treated with modern antidepressants, Prozac, Zolof, etc.These
antidepressants work by modifying the Serotonergic Receptor Sites. Are patients taking both Propulsid and a 5-Ht/ Antidepressant?

Remember, BENEFITS and RISKS, The Gastric Contents can Reflux no
Matter what the pH. and Propulsid and Prozac do not make good company.
Avatar universal
i have bad gas sometimes and the doctor gave me pantoloc to take every morning. i feel werd before the gas comes out both ends. when i dont take the panoloc iget bad gas pains in my chest and a burning pain. i have an endoscoby and he said my stomach looks fine. the heart specialist said every thing looks good. idont know what to do next. need help thanks ray
Avatar universal
I have pains in my lower abdomen and upper stomach below my ribs and I have been on prilosec for over a year.  What is the solution to this problem?
Avatar universal
Went to the doctor.  She is advising all of her patients to quit taking Propulsid.  Said there are just too many side effects beyond even the heart problems.  Since I am on medication for high blood pressure, she advised that I not only not double the dosage as prescribed by the allergist, but I not take it at all.  She prescribed metoclopramide (can't tell you the non-generic name because I can't remember it).  She said it has side effects of cramping (can be in neck, tongue, etc.) and that benadryl will stop the cramping.  That's how you know not to take it again!  Not sure I want to take that one either but will give it a try.  Sure is cheaper!  If I am unable to take it, then we will do all the cardiac testing before going back to Propulsid.

I am aware that Propulsid reacts with medications, but was not aware that my blood pressure medication was one of them.  Guess I'm lucky that I've been on it this long without a problem.  I also was not aware that grapefruit does strange things in connection with Propulsid -- and am not worried about that side effect -- pigs would fly before I would willingly eat grapefruit and suffer the consequences of grapefruit reflux!  Not on any drugs for depression.

As for the Prilosec, she said that even though the drug insert still states that it should be taken in cycles of 4 to 6 weeks, it is safe to take long term and that people have been taking it daily for years with no problems.


Thanks all for your responses.
Avatar universal
I have been on lozec and cicapride for two yrs, I also been taken erytromycin 250 , I don't see any change, still have the same pain, seemed this was all for nothing, As far as I'm concerned, we are just guiney pigs for all the Doc. to work on us.           thank you
Avatar universal
my daughter has been on priolosec for three years and she is three years old.  she is on it for reflux and stomach empting.  my doctors and they are out of Childrens hospital of philadelphia run her through an ekg every year to test the heart due to the side effects.  there have been none.  its a good drug and it does work so ask for heart monitoring yearly for protection.
Avatar universal
I'm so upset with all the doctors, because of all this medication that I was taking, now my immune system is all mix up,and still in a lot of pain, the only pain killer I can take is "demoral" but I got addictite to it so I stop for a while, but I had to go back to it but take it moderate,if anybody has anything to tell me ,please do so,I need new ways of dealing with the pain and to manage my life. I thank you.
Avatar universal
I am 22 years old suffering from idiopathic gastroparesis for six years.  I took
propulsid for the gastroparesis for a year and then my doctor increased my dose because
I was getting worse.  After the dosage increase, I went into cardiac arrest three times
once where I had no heartbeat or breathing for five minutes and was unconscious for ten.
I am so fortunate to have survived that without permanent damage.  I had no previous history
of cardiac problems.  Six months later, after another cardiac arrest while I was off of propulsid
and e-mycin, I was diagnosed with prolonged QT interval, so I do have a heart problem that
my doctors did not know about when I took these drugs and they almost killed me.  I have heard of
fatal cardiac arrythmias in patients without documented cardiac problems because of propulsid.
While I was in the hospital for that reaction, the doctors told me it was rare for people to
react without a history of heart problems.  I did, but they didn't know about my problems.  They
MIGHT not have shown up if I had not taken the propulsid, or did not suffer from gastroparesis
which causes my potassium to drop which makes me go into these arrythmias.  Be sure to talk to
your doc about propulsid.  I'm terrified of the drug, and with good reason!  If you have any
more questions, feel free to e-mail me at ***@****.  Good luck!
Avatar universal
Hi: I'm a 40 year old who has been diagnosed with Gerd. My G.I. doctor said I have a motility disorder also. He said I have no other alternative but to take PROPULSID. After reading some of the letters on here I'm terrified about taking it. I had a E.K.G.done. It was normal(420). My doctor said they like to keep it down around 400-410(cardiac Arrythmias). I also Regurgitate after almost every meal. Sometimes even water will come back up. My doctor said surgery will make it worse. My place of employment
will be changing insurance as of 3-1-00 to a H.M.O. After that I will not be able to use my same doctor. I'm so depressed about the insurance. The only thing I'm not constipated since I'm taking propulsid. So I just don't know what to do. I was told about 7 years ago their is nothing that will help me and should stop shopping for doctors. It seems like nobody can help me. Can the propulsid hurt me if the E. K. G. was fine.  Thanks for listening.                                
Avatar universal
Hi: I'm a 40 year old who has been diagnosed with Gerd. My G.I. doctor said I have a motility disorder also. He said I have no other alternative but to take PROPULSID. After reading some of the letters on here I'm terrified about taking it. I had a E.K.G.done. It was normal(420). My doctor said they like to keep it down around 400-410(cardiac Arrythmias). I also Regurgitate after almost every meal. Sometimes even water will come back up. My doctor said surgery will make it worse. My place of employment
will be changing insurance as of 3-1-00 to a H.M.O. After that I will not be able to use my same doctor. I'm so depressed about the insurance. The only thing I'm not constipated since I'm taking propulsid. So I just don't know what to do. I was told about 7 years ago their is nothing that will help me and should stop shopping for doctors. It seems like nobody can help me. Can the propulsid hurt me if the E. K. G. was fine.  Thanks for listening.                                
Avatar universal
I have gastroparesis as does my teenage daughter.  We both take propulsid, and I am not afraid for us to take it.  We have frequent EKGs and have always had normal results and no problems re QT intervals.

Propulsid is in my opinion, however, overprescribed.  Some people have illnesses, many of them extremely serious, that can be treated effectively with other medications.  However, for gastroparesis patients propulsid is a very necessary alternative.

If you have an illness that can be treated with another medication, then take the alternative drug.  If you are calling the drug company and asking them to take propulsid off the market, please do not do so. Without propulsid, many seriously ill people will worsen or even die.  My daughter's life was saved with propulsid in conjuction with other medications.  So was mine.  Without it, I don't know what would happen to us.
  
To Sue -- it sounds as though you do have a motility disorder.  Have regular EKGs while you take propulsid.  Do you have a nausea medication?  Zofran, a drug developed for chemotherapy patients, is very effective for some people.  It is also quite expensive, however, and some insurance will not pay for it.  Good luck.
Avatar universal
Carissa,

While rereading this, I felt I did not address your very real concerns and terrible experience with propulsid.  If you were taking e-mycin with propulsid you were indeed in great danger.  We are having bracelets made that indicate we are taking propulsid and SHOULD NOT be given e-mycin.  These drugs are a definite danger when combined.

I am so sorry that you had such a close call.  Doctors must be educated as to when these drugs should be prescribed and how.  They must monitor their patients and not mix propulsid with certain other prescriptions.  I hope you are doing better.

deb
Avatar universal
Wow, this sounds scary....

I just stumbled upon this link and have been reading about many individuals expereinces with Propulsid.  Well, let me share my situation, and please, if anybody has any advice I am more than willing to listen....

I was diagnosed with IBS about 6 years ago and was put on Levsinex and Propulsid (10mg 3 times a day).  I never did really understand what each drug's purpose was, I just followed my specialist's orders.  For the first time I was (and still am) pain free.  But I am concerned about propulsid.  I recently became aware that its primary purpose is to control gastric reflux.  I never had a problem with that.  So I'm a bit confused why that is part of my IBS program.  Further, I have noticed for years that on occasion my heart beats strangely (skipping a beat?).  I'm in my mid 30's and very healthy otherwise.  I lift weights regularly and never had any indication of heart problems, although I do feel noticebly more fatigued than I did before taking the drugs (could just be me getting older).

Anybody (M.D.'s, IBS patients) have any insight into why/if I should be even taking propulsid for IBS???  Any recommended substitutions to look into?

Thanks,

    Bob R.  (BobbyR_66***@****)
Avatar universal
Bob,

If you had constipation as a predominant symptom that
may be why Propulsid was prescribed?? It can effect the
intestines as well as the stomach re:motility(it will speed things up).I would also ask your Primary or GI doc about a EKG.As the warning says it should be used as a last resort and that a EKG should be obtained if it is going to be used.Also IF the Levsinex has anticholergic (sp??) effects,which means it can
slow the motility and cause constipation,the Propulsid maby
was prescribed to counteract that effect????Obvoiusly Im not
a Dr this is just a guess??
If you do have constipation there are other
options,natural and RX .I have gastroparesis and am unable to
eat enough/any fibre so I take Mirilax.I just thought of something else, I have a sinus arythmia its harmless but sometimes my heart will kindof...gallop or flutter/palpitate.
Im glad to hear you doig well!! I hope all works out for you.
Good Luck
Jeannine
Avatar universal
Hi again,

I just read that Levsinex can cause heart palpitations
or racing heart symptoms and it said to inform your Doc
if you have these symptoms.

Jeannine
Avatar universal
I have been on Propulsid 40 mg. 3 X day for almost 6 years.  I also have the thought that it is bad for you.  My doctor keeps telling me it is the only medicine I can take at the moment.  My question to any one out there is do we believe these doctors or not.
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