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Propulsid and Sustiva

Determining the interaction of Propulsid and Sustiva and the possibility of their joint administration.

Check result:

Propulsid <> Sustiva

Relevance: 22.08.2023 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:

Using cisapride together with efavirenz is not recommended. Combining these medications may significantly increase the blood levels and effects of cisapride. High blood levels of cisapride can occasionally cause an irregular heart rhythm that may be serious. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, or fast or pounding heartbeats during treatment with cisapride. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor. **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:

CONTRAINDICATED: Based on in vitro data, coadministration with the non-nucleoside reverse transcriptase inhibitors (NNRTIs), delavirdine and efavirenz, may increase the plasma concentrations of cisapride. The mechanism is NNRTI inhibition (both competitive and non-competitive) of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of cisapride. Although the interaction has not been specifically studied with either NNRTI, 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.

MANAGEMENT: Given the potential for serious and life-threatening adverse cardiac events associated with increased plasma levels of cisapride, the concomitant use with delavirdine or efavirenz is considered contraindicated.

References

Hill SL, Evangelista JK, Pizzi AM, Mobassaleh M, Fulton DR, Berul CI "Proarrhythmia associated with cisapride in children." Pediatrics 101 (1998): 1053-6
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
Gray VS "Syncopal episodes associated with cisapride and concurrent drugs." Ann Pharmacother 32 (1998): 648-51
Michalets EL, Williams CR "Drug interactions with cisapride: clinical implications." Clin Pharmacokinet 39 (2000): 49-75
Dresser GK, Spence JD, Bailey DG "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet 38 (2000): 41-57
"Product Information. Sustiva (efavirenz)." DuPont Pharmaceuticals, Wilmington, DE.
Bran S, Murray WA, Hirsch IB, Palmer JP "Long QT syndrome during high-dose cisapride." Arch Intern Med 155 (1995): 765-8
"Product Information. Rescriptor (delavirdine)." Pharmacia and Upjohn, Kalamazoo, MI.
Lewin MB, Bryant RM, Fenrich AL, Grifka RG "Cisapride-induced long QT interval." J Pediatr 128 (1996): 279-81

Propulsid

Generic Name: cisapride

Brand name: Propulsid

Synonyms: Propulsid (Suspension)

What is Propulsid?

Sustiva

Generic Name: efavirenz

Brand name: Sustiva

Synonyms: n.a.

What is Sustiva?

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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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