Warning Cisapride - off market for humans, bad for cats

[Jojo&Tutu]

Just wanted all cat owners to know that Cisapride was pulled off market for humans. Only one pharmacy in Arizona has the remaining material. A few years ago my internal medicine vet wanted my cat to use Cisapride for her constipation. When I was in Scottsdale visiting my mom at her winter home we took a drive north to the pharmacy that has the remaining stock and I spoke to the head pharmacist. I was told by the pharmacist the reason it was taken off market by the FDA for humans is that although it causes the bowel to contract the heart muscle is the same type of muscle as the bowel and it was causing problems for the heart such as heart attack. I switched to adding a teaspoon to a half tablespoon of organic pumpkin baby food to each of my cat’s canned food. Then when that didn’t seem to help enough my new internal medicine vet recommended using a probiotic. I add 1/2 to 2/3 of a capsule of Proviable probiotic for small animals per can of her cat food - sprinkle it on and mix it in and my cat’s stool is nice and soft compared to the little hard rocks that would get stuck as they were before. I am now able to cut back on the pumpkin per can too. A much healthier alternative!!!!

 

[LTS3]

Can you provide a link to a recent article / news story / etc about Cisapride being pulled off the market?

 

[Jojo&Tutu]

I do not have a link. I was told this in person by the head pharmacist of the only pharmacy that still carries the Cisapride product. This was at least four years ago I think as my mom has since sold her Scottsdale condo. You can check with the FDA as he told me it was pulled off market for humans for that reason.

 

[LTS3]

The FDA pulled Cisapride for Human use in 2000. Cisaprisde is not approved for use in animals but many vets prescribe it "off label". It is still available today for off label veterinary use, mostly to treat megacolon.

If there are any concerns about using Cisapride for a pet, it's best to discuss it with the vet.

 

[kittenmittens84]

Does Cisapride have the same documented potential for cardiac side effects in animals as it does in humans? Drugs don’t always have the same effects in different species, I wouldn’t jump to the assumption that a med with certain mechanisms of action in humans works the same way on cats. In this case it’s one of the many drugs that can cause long QT syndrome in humans, which basically means your heart takes longer than it should to “prepare” for the next heartbeat, usually because the electrical signals in the heart aren’t working right. Drugs that mess with these signals including cisapride usually do so by affecting the channels that ions like potassium move through in the body (hence why electrolyte imbalance can also cause long QT), and these complex systems aren’t the same in humans and cats!

Did your vet say anything about side effects when he prescribed it for your cat? I was under the assumption it was fairly well tolerated but I could be wrong!

 

[LTS3]

Does Cisapride have the same documented potential for cardiac side effects in animals as it does in humans? Drugs don’t always have the same effects in different species, I wouldn’t jump to the assumption that a med with certain mechanisms of action in humans works the same way on cats.

Veterinary Partner, a reputable source of information for pet owners, has this info on Cisparide for veterinary use:

Cisapride (Propulsid) - Veterinary Partner - VIN

veterinarypartner.vin.com

Side effect in pets are diarrhea and cramping, mostly if the dose is too high.

Wedgewood Pharmacy has this info:

Cisapride for dogs and cats: Uses, Dosage & Side Effects

Cisapride is commonly prescribed for motility disorders of the gastrointestinal (GI) tract in dogs, cats, and horses.

www.wedgewoodpetrx.com

I doubt a Human pharmacist knows how a Human drug affects pets. While it's great that the pharmacist told the OP about the Cisparide being pulled for serious side effects in people, it's best to double check the info with the vet and ask if the medicine has the same effect on pets or not and what alternative medicines can be used.

 

[Meowmee]

Just wanted all cat owners to know that Cisapride was pulled off market for humans. Only one pharmacy in Arizona has the remaining material. A few years ago my internal medicine vet wanted my cat to use Cisapride for her constipation. When I was in Scottsdale visiting my mom at her winter home we took a drive north to the pharmacy that has the remaining stock and I spoke to the head pharmacist. I was told by the pharmacist the reason it was taken off market by the FDA for humans is that although it causes the bowel to contract the heart muscle is the same type of muscle as the bowel and it was causing problems for the heart such as heart attack. I switched to adding a teaspoon to a half tablespoon of organic pumpkin baby food to each of my cat’s canned food. Then when that didn’t seem to help enough my new internal medicine vet recommended using a probiotic. I add 1/2 to 2/3 of a capsule of Proviable probiotic for small animals per can of her cat food - sprinkle it on and mix it in and my cat’s stool is nice and soft compared to the little hard rocks that would get stuck as they were before. I am now able to cut back on the pumpkin per can too. A much healthier alternative!!!!

You are right. It does cause arrhythmia in cats as well. I would not use it. When I was in hospital they tried to give me this drug under another name I believe one ingredient was changed, but I refused it. I had been given it in the past, had palpitations and had read about the cardiac reactions later. I stopped it after one dose. Pumpkin etc is a lot safer and it worked fine for Wizard when he had bad constipation.

Cisapride for Dogs and Cats

General Drug Information and Indications for Cisapride for Dogs and Cats from Wedgewood Pharmacy.

www.wedgewoodpetrx.com

 

[LTS3]

You are right. It does cause arrhythmia in cats as well.

The risk of arrhythmia is increased in people if other medications are used at the same time. From Veterinary Partners:

The drug interaction that led to removing cisapride from the human market was the induction of ventricular (heart) arrhythmias when cisapride was used with the antifungal agents ketoconazole or itraconazole, or with silymarin, the active ingredient in milk thistle supplements (commonly used to support liver function). Additional medications that could lead to arrhythmias with cisapride include: chloramphenicol (an antibiotic); amiodarone (a heart medication); clarithromycin (an antibiotic); cimetidine (the antacid mentioned above); procainamide (a heart medicine); sotalol (a heart medicine); and of the macrolide class of antibiotics (with the exception of azithromycin); and tricyclic antidepressants such as amitriptylline.


Again, if there are any concerns about using Cisparide, discuss it with the vet

 

[Meowmee]

The risk of arrhythmia is increased in people if other medications are used at the same time. From Veterinary Partners:

The drug interaction that led to removing cisapride from the human market was the induction of ventricular (heart) arrhythmias when cisapride was used with the antifungal agents ketoconazole or itraconazole, or with silymarin, the active ingredient in milk thistle supplements (commonly used to support liver function). Additional medications that could lead to arrhythmias with cisapride include: chloramphenicol (an antibiotic); amiodarone (a heart medication); clarithromycin (an antibiotic); cimetidine (the antacid mentioned above); procainamide (a heart medicine); sotalol (a heart medicine); and of the macrolide class of antibiotics (with the exception of azithromycin); and tricyclic antidepressants such as amitriptylline.


Again, if there are any concerns about using Cisparide, discuss it with the vet

Yes the risk is increased with other meds but there is still a risk of that with just that med itself. Not a med I would use for my cat. And reactions can often be the same in people, cats, dogs etc. so pharmacists know about various reactions, not simply dvm.

 

[Norachan]

Again, if there are any concerns about using Cisparide, discuss it with the vet

Yes, that's about the best advice we can give.

 

[terris]

My 12 year old cat has had constipation issues for a few years. He’s had enemas several times at his vets office, he’s currently on lactulose, and his vet just prescribed cisapride, which is what brought me to this thread.
He was also recently diagnosed with hyperthyroidism and has been taken methimazole for the past few months, one 5mg tablet every 12 hours. His constipation issues have been acting up again, since being on the methimazole, which is why I believe his vet recently prescribed the cisapride.
After reading this thread, I am seriously thinking of taking him off the cisapride and trying the Proviable probiotic.
My question is, is it safe to give him Proviable probiotic (instead of cisapride), and continue with lactulose and his Methimazole? I realize I should be asking my vet this question, but I honestly do not want her to know, at this time, that I may stop giving him the cisapride and that I’m thinking to give him a probiotic instead. Or maybe even give him 1/2 the dose of cisapride that she prescribed, along with all the above (including the probiotic)? We all know how some Dr.’s are when we do research online. I just want the best for him. I hate the idea that he is on 3 prescriptions and if I can swap one for a healthier alternative, that would be in his best interest. After reading this thread about cisapride, its really has me thinking.
Thanks for any advise!

 

[Norachan]

I strongly recommend talking to your vet about this T terris

There are so many factors to take into account when medicating a cat. If your cat is prescribed multiple forms of medication you also have to consider how those drugs will affect each other.

It's not worth the risk of trying to work out how best to medicate your cat according to Dr Google. If you're not happy with your vet then look for another one, but don't change your cats medication based on something you read online.

 

[Jojo&Tutu]

One thing I’ve learned over the years is that my cat needs more fluids. Since I started using lactated ringers (subq fluids) under her skin (about 50 mg for a small cat works really well) her stools are better. They also improved a lot switching her from red meat venison to rabbit and also turkey or chicken might work better too. Red meat is hard on the kidneys for older cats. I figured that out as my cats kidney function began to deteriorate a little and her stools got harder. I was able to eliminate pumpkin added into her food with the change of food away from red meat. Have your vet keep an eye on blood pressure if your cat is hyperthyroid and check for thyroid adenoma. Blood pressure affects kidney function and kidney function affects fluid levels in the cat and it all affects how dry the stools are. Proviable DC added into her food once a day has helped my cat along with Epakitin added into her food twice a day. If nothing else try pumpkin baby food. It helped my cat a lot until I changed her food to get her off red meat and added in sub q fluids. Good luck and my advise is to stay away from Cisapride unless there is no alternative.