Cisapride Propulsid


Cisapride is thought to enhance the release of acetylcholine at the myenteric plexus, thus promoting peristalsis. Selected Indications

Gastrointestinal dysmotility, systemic sclerosis. Metabolism

Cisapride is rapidly absorbed via the gastrointestinal tract, and peak plasma levels are reached within 2 hours. Gastrointestinal absorption is enhanced by concomitant administration of cimetidine and ranitidine. The mean half-life is between 6 and 12 hours. It is metabolized by the cytochrome P-450 3A4 enzyme. Its metabolites are excreted in both feces and urine. Although hepatic or renal impairment may cause accumulation of metabolites within plasma, no dose adjustments are generally necessary.

Adverse Reactions

Headache, sedation, nausea, and diarrhea are the most commonly reported adverse effects. These problems appear to be dose-dependent. Caution

Rare cases of serious cardiac arrhythmias, including ventricular arrhythmias and torsades de pointes, have been reported; therefore, the use of cisapride in patients with conditions associated with QT prolongation should be avoided. Concomitant administration of drugs that inhibit cytochrome P-450 3A4 activity (e.g., ketoconazole, itraconazole, micronazole, erythromycin, and troleandomycin) may raise cisapride levels to cause prolongation of the QT interval and so is contraindicated. Cisapride may enhance the effects of sedatives.


Tablets, 10 and 20 mg. Dosage

The dosage is 10 to 20 mg up to four times daily, taken orally 15 to 30 minutes before meals. Hyaluronans (Hyalgan, Synvisc)


Increases viscoelasticity of synovial fluid and possibly reduces cartilage degradation.

Selected Indications Osteoarthritis.


High-molecular-weight fractions of sodium hyaluronate for sterile intraarticular injection are derived from chicken combs and are available in a buffered physiologic sodium chloride solution. The intraarticular half-life of sodium hyaluronate is less than 24 hours. Hylan G-F is a cross-linked derivative of sodium hyaluronate and appears to have a longer half-life. Hyaluronans are degraded by intraarticular enzymes, free radicals, and sheer forces. The degradation products are removed through lymphatics and undergo hepatic catabolism.

Adverse Reactions

Most adverse effects are related to symptoms associated with the site of injection, including pain, swelling, effusion, warmth, and redness. Some of these cases are exacerbations of gout or pseudogout. Self-limited allergic reactions have been reported.


At present, hyaluronans are approved only for osteoarthritis of the knee. Increases in knee inflammation after administration in the setting of inflammatory arthritides (e.g., RA and gout) have been noted. Because the source of the agent is rooster combs, precaution should be taken in patients with allergies to avian proteins, feathers, and egg products. Strict sterile technique is to be observed, and no injection should be attempted through skin that appears infected. Disinfectants containing quarternary ammonium salts should not be used for skin preparation.


Sodium hyaluronate (Hyalgan), sterile 2-mL vials. Hylan G-F 20 (Synvisc), sterile 2-mL prefilled syringes.


Sodium hyaluronate, 2 mL administered weekly by intraarticular injections during 5 weeks. Hylan G-F 20, 2 mL administered weekly by intraarticular injections during 3 weeks.

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