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Cisapride works on the acetylcholine release and blocks the dopamine receptors, but to a lesser effect than metoclopramide HCl. This will affect mainly the motility of the GI tract. It acts mainly on the lower esophageal sphincter, increases the pressure in the lower part of the esophagus. It has thus an activating effect on the lower esophageal peristasis and accelerates the emptying of the stomach content into the intestine, but does not affect gastric secretion, and enhances peristalsis of the small intestine and colon. Cisapride is used mainly in the treatment of gastric disorders and megacolon.
Since the body adapts to the presence of a gut motility drug, and stops producing its own molecules that normally stimulate the GI tract, it is advisable not to stop the administration of gut motility drugs abruptly. If so, the onset of stasis is often observed. Their dose should be decreased daily over a period of a week or more, so that the body can start the production of its own molecules/hormones gradually again.
Adverse effects: cisapride should not be used in case of gastro-intestinal bleeding, total blockage or with a perforated intestine. Other effects are toxicosis with diarrhea, tremors, convulsions, etc. In case of renal failure, history of epilepsy (rare in rabbits), or gastric obstruction, the drug should not be used.
This drug should to be given 15 to 30 min before a meal. When it is given together with other drugs that are absorbed in the stomach, one should keep in mind that its absorption will be decreased; the contrary for drugs to be absorbed in the intestine. Cisapride increases the effect of cimetidine, anticoagulants or benzodiazepine. Concurrent use of cisapride with ketoconazole, itraconazole or miconazole may result in the appearance of ventricular arrythmias.
The use of anticholinergic agents will negate the effect of beneficial effects of cisapride.
Though little scientific evidence is available, cisapride seems to stimulate the voiding of the bladder, but only if there is no nerve damage.
Dosage safe for use in rabbits: 0.5 mg/kg once daily to tid - qid, PO, SC.
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