Cisapride and Fatal Arrhythmia

Wysowski, Diane K.; Bacsanyi, Janos

doi:10.1056/nejm199607253350416

Cited by 298 publications

(186 citation statements)

References 4 publications

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“…Transit times are improved, however, cardiac arrhythmias have been noted with long-term use. 54 SCI patients with UMN lesions can exploit the rectocolic re¯ex to eect defecation. Digital stimulation can result in a re¯ex wave of conus-mediated rectal peristalsis.…”

Section: Current Management Strategiesmentioning

confidence: 99%

Bowel dysfunction following spinal cord injury

et al. 2001

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Study Design: Review. Objectives: To outline the present knowledge of bowel dysfunction following spinal injury, and look at future directions of management and research. Setting: Spinal Unit and Colorectal Unit, Christchurch, New Zealand. Methodology: Review. Results: The underlying physiology of colorectal motility and defecation is reviewed, and consequences of spinal cord injury on defecation are reported. A discussion of present management techniques is undertaken and new directions in management and research are suggested. Conclusion: There is need for more intervention in regard to bowel function that could improve quality of life, but there is also a need for more research in this area.

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Section: Current Management Strategiesmentioning

confidence: 99%

Bowel dysfunction following spinal cord injury

et al. 2001

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“…Serious adverse events in infants have not been reported in clinical trials. Package labelling indicates isolated reports of more serious adverse events:notably extrapyramidal reactions, seizures in epileptic patients, cholestasis in very prematures [50] (not confirmed by others [65]), and cardiac interactions with 'azole antifungals' (ketokonazole, fluconazole, itraconazole, miconazole), erythromycin, claritromycin and troleandomycin [142]. All these medications are metabolized by the cytochrome P-450 3A4 isozyme.The cardiac effects appear to be associated with high plasma cisapride levels as recently illustrated by an adult case [11] and by two cases of cisapride poisoning [141].…”

Section: Cisapridementioning

confidence: 99%

A critical appraisal of current management practices for infant regurgitation - recommendations of a working party

Vandenplas

Belli²,

Benhamou

et al. 1997

European Journal of Pediatrics

126

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A critical appraisal of current management practices for infant regurgitation: recommendations of a working party Vandenplas, Y.; Belli, D.; Benhamou, P.; Cadramel, S.; Cezard, J.P.; Cucchiara, S.; Dupont, C.; Faure, C.; Gottrand, F.; Hassall, E.; Heymans, H.S.A.; Kneepkens, C.M.F.; Sandhu, B. Published in:European Journal of Pediatrics DOI:10.1007/s004310050613Link to publication Citation for published version (APA):Vandenplas, Y., Belli, D., Benhamou, P., Cadramel, S., Cezard, J. P., Cucchiara, S., ... Sandhu, B. (1997). A critical appraisal of current management practices for infant regurgitation: recommendations of a working party. European Journal of Pediatrics, 156, 343-357. DOI: 10.1007/s004310050613 General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Abstract Regurgitation is a common manifestation in infants below the age of 1 year and a frequent reason of counselling of general practitioners and paediatricians. Current management starts with postural and dietary measures, followed by antacids and prokinetics. Recent issues such as an increased risk of sudden infant death in the prone sleeping position and persistent occult gastrooesophageal reflux in a subset of infants receiving milk thickeners or thickened ''anti-regurgitation formula'' challenge the established approach. Therefore, the clinical practices for management of infant regurgitation have been critically evaluated with respect to their efficacy, safety and practical implications.

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“…1 Cisapride was the fifth drug to be withdrawn from the market in the span of 3 years, highlighting a growing problem and the need to better identify drugs with a proclivity to induce TdP during preclinical and clinical stages of development. The present study was designed to determine the electrophysiological actions of cisapride in the canine isolated arterially perfused left ventricular wedge preparation, an experimental model previously shown to develop TdP arrhythmias in response to QT-prolonging agents capable of augmenting transmural dispersion of repolarization (TDR).…”

mentioning

confidence: 99%

Cisapride-Induced Transmural Dispersion of Repolarization and Torsade de Pointes in the Canine Left Ventricular Wedge Preparation During Epicardial Stimulation

2003

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Background-Cisapride, a gastrointestinal prokinetic agent, was recently withdrawn from the market because of its propensity to induce torsade de pointes (TdP) arrhythmias. The present study examines the electrophysiological actions of cisapride in the isolated arterially perfused canine left ventricular wedge preparation. Methods and Results-Transmembrane action potentials from epicardial and M regions and a pseudo-ECG were simultaneously recorded. Cisapride (0.1 to 5 mol/L) was added to the coronary perfusate. Cisapride prolonged the QT interval and increased transmural dispersion of repolarization (TDR) at relatively low but not at high concentrations. TdP could be induced with programmed electrical stimulation only at a low concentration of drug (0.2 mol/L), when TDR was maximally prolonged. Moreover, TdP could only be induced during epicardial (but not endocardial) activation of the wedge, which was found to augment TDR. At higher concentrations of cisapride, QT was further prolonged, TDR was diminished, and TdP could no longer be induced. T peak -T end interval and T peak -T end area provided reasonable electrocardiographic indices of TDR. Conclusion-Our data (1) demonstrate a biphasic concentration/response relationship for the effect of cisapride to induce long-QT syndrome and TdP, (2) show the value of the left ventricular wedge preparation in identifying drugs that pose an arrhythmic risk, (3) support the hypothesis that risk for development of TdP is related to the increase in TDR rather than to prolongation of the QT interval, and (4) indicate that epicardial activation of the left ventricle, as occurs during biventricular pacing, can facilitate the development of TdP under long-QT conditions.

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Cisapride and Fatal Arrhythmia

Cited by 298 publications

References 4 publications

Bowel dysfunction following spinal cord injury

Bowel dysfunction following spinal cord injury

A critical appraisal of current management practices for infant regurgitation - recommendations of a working party

Cisapride-Induced Transmural Dispersion of Repolarization and Torsade de Pointes in the Canine Left Ventricular Wedge Preparation During Epicardial Stimulation

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