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Cimetidine Tablets and Propulsid

Determining the interaction of Cimetidine Tablets and Propulsid and the possibility of their joint administration.

Check result:

Cimetidine Tablets <> Propulsid

Relevance: 15.08.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Cisapride is no longer on the market in the US. Do not take cisapride with any other medication. **Cisapride (Propulsid) is no longer marketed in the United States. You should only be taking cisapride if you are obtaining the medication from your doctor though a Limited Access Program developed jointly by the manufacturer and the FDA.**

Professional:

GENERALLY AVOID: Coadministration with cimetidine may increase the plasma concentrations of cisapride. The mechanism is cimetidine inhibition of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of cisapride. In eight healthy volunteers, cimetidine (400 mg orally three times a day) increased the steady-state peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of cisapride (10 mg orally three times a day) by 45% each. No adverse effects have been attributed to this interaction, although high plasma levels of cisapride have been associated with prolongation of the QT interval on the ECG; ventricular arrhythmias including ventricular tachycardia, ventricular fibrillation, and torsade de pointes; cardiac arrest; and sudden death. Conversely, cisapride may accelerate but decrease the extent of gastrointestinal absorption of cimetidine. In the eight volunteers, the time to reach peak concentration (Tmax) of cimetidine reduced by about one-half during coadministration with cisapride, and the bioavailability decreased by 18%.

MANAGEMENT: Given the potential for serious and life-threatening adverse cardiac events associated with increased plasma levels of cisapride, concurrent use of cimetidine should be avoided if possible. Other H2-receptor antagonists (e.g., famotidine, nizatidine, ranitidine) have not been shown to significantly inhibit CYP450 3A4 and may be safer alternatives during therapy with cisapride.

References

"Product Information. Propulsid (cisapride)." Janssen Pharmaceutica, Titusville, NJ.
Dresser GK, Spence JD, Bailey DG "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet 38 (2000): 41-57
Desta Z, Soukhova N, Mahal SK, Flockhart DA "Interaction of cisapride with the human cytochrome P450 system: metabolism and inhibition studies." Drug Metab Dispos 28 (2000): 789-800
Lewin MB, Bryant RM, Fenrich AL, Grifka RG "Cisapride-induced long QT interval." J Pediatr 128 (1996): 279-81
Michalets EL, Williams CR "Drug interactions with cisapride: clinical implications." Clin Pharmacokinet 39 (2000): 49-75
Gray VS "Syncopal episodes associated with cisapride and concurrent drugs." Ann Pharmacother 32 (1998): 648-51
Bran S, Murray WA, Hirsch IB, Palmer JP "Long QT syndrome during high-dose cisapride." Arch Intern Med 155 (1995): 765-8
Kirch W, Janisch HD, Ohnhaus EE, van Peer A "Cisapride-cimetidine interaction: enhanced cisapride bioavailability and accelerated cimetidine absorption." Ther Drug Monit 11 (1989): 411-4
Hill SL, Evangelista JK, Pizzi AM, Mobassaleh M, Fulton DR, Berul CI "Proarrhythmia associated with cisapride in children." Pediatrics 101 (1998): 1053-6
Bedford TA, Rowbotham DJ "Cisapride: drug interactions of clinical significance." Drug Saf 15 (1996): 167-75

Cimetidine Tablets

Generic Name: cimetidine

Brand name: Tagamet HB, Tagamet

Synonyms: Cimetidine

What is Cimetidine Tablets?

Propulsid

Generic Name: cisapride

Brand name: Propulsid

Synonyms: Propulsid (Suspension)

What is Propulsid?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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