Can Cisapride be used for increased motility?

• A. Yes, it can be used
• B. No, as the agent was withdrawn from the US market in 2000 due to increasing reports of cardiac dysrhythmias
• C. Only under cardiology supervision
• D. Yes, but only in pediatric patients

Answer: (B)

Cisapride increases GI motility by acting as a 5-HT4 receptor agonist, which boosts acetylcholine release in the enteric nervous system. However, its use is limited by serious cardiac safety concerns. It was withdrawn from the US market in 2000 after reports of QT prolongation and torsades de pointes, especially when combined with drugs that raise its levels (notably certain macrolide antibiotics and azole antifungals that inhibit metabolism). Because of this safety withdrawal, it is no longer used to enhance motility in routine practice in the US. The statement reflecting its market withdrawal due to cardiac dysrhythmias best explains why it cannot be used.