Drug Comparisons

Promotility Agents are used to stimulate the movement of gastrointestinal contents through the esophagus, stomach, and intestines. This can reduce the potential damage stomach acids can inflict on the lining of the stomach or esophagus. Emptying the stomach reduces the amount of food it contains and decreases the chance of refluxing acid into the esophagus, which can cause heartburn or gastroesophageal reflux disease (GERD).

Drugs in this Class
Metoclopramide Tablets (Reglan Tablets)
Cisapride Tablets (Propulsid)
Bethanechol (Urecholine)
Metoclopramide Solution for Injection (Reglan Solution for Injection)

Summarizing the Evidence

• Cisapride may offer improved effectiveness in treating GERD symptoms when compared to metoclopramide. However, cisapride has been removed from the market since August 2000 due to serious heart-related side effects that can potentially occur when cisapride is taken with certain drugs. Cisapride is still available on a limited basis to certain patients, but should be used as a last-line treatment for GERD. All patients who receive cisapride must have appropriate monitoring with an electrocardiogram ("EKG") prior to the start of treatment, and close monitoring of potassium and magnesium levels in the blood--talk to your doctor for more information.

• Metoclopramide is not associated with potentially life threatening, heart-related side effects like cisapride, but it is still associated with various side effects such as involuntary movements of the limbs or eyes and spasm of the neck, face, and jaw muscles.

• Studies have shown the benefits of both cisapride and metoclopromide in the treatment of GERD; however, these medications are typically not the first treatment of choice for this condition.

• Both cisapride and metoclopromide should be reserved for the treatment of GERD in patients who have symptoms that are uncontrolled with either a proton pump inhibitor (like Aciphex, Nexium, Prevacid, Prilosec, or Protonix) or an H2 blocker (like Axid, Pepcid, Tagamet, Zantac) or they may be used in combination with proton pump inhibitors or H2 blockers.

• Finally, these medications are more typically used to treat critically ill patients in hospital intensive care units in order to improve their gastrointestinal motility (ability to move contents through the stomach and intestines).

Dosing and Administration

• Both cisapride and metoclopramide should be taken on an empty stomach four times daily, a disadvantage compared to the convenient once or twice daily dosing with proton pump inhibitors and H2 blockers.

Generic Availability

• Metoclopromide is available in generic versions. Cisapride (Propulsid) is not available generically, and is only available on a limited basis to patients meeting strict criteria for its use.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

1. Berardi RR, Welage LS. Peptic Ulcer Disease. In: Pharmacotherapy A Pathophysiologic Approach. 6th ed. Dipiro JT, Talbert RL, Yee GC et al. (eds). McGraw-Hill. New York. 2005. pg. 629-648.

2. Drugdex Database. In: Thomson-Micromedex. Greenwood Village, CO. 2006.

3. Drug Facts and Comparisons. Wolters Kluwer Health. St. Louis, MO; 2007.

4. MacLaren R, Patrick WD, Hall RI, et al. Comparison of cisapride and metoclopramide for facilitating gastric emptying and improving tolerance to intragastric enteral nutrition in critically III, mechanically ventilated adults. Clin Ther 2001 Nov;23(11):1855-66.

5. Booth CM, Heyland DK, Paterson WG. Gastrointestinal promotility drugs in the critical care setting: A systematic review of the evidence. Crit Care Med. 2002 Jul;30(7):1429-35.

6. Champion MC. Prokinetic therapy in gastroesophageal reflux disease. Can J Gastroenterol 1997 Sep;11 Suppl B:55B-65B

7. Wiseman LR & Faulds D: Cisapride: an updated review of its pharmacology and therapeutic efficacy as a prokinetic agent in gastrointestinal motility disorders. Drugs 1994; 47:116-152.

8. Manousos ON, Mandidis A & Michailidis D: Treatment of reflux symptoms in esophagitis patients: comparative trial of cisapride and metoclopramide. Curr Ther Res 1987; 42:807-813.

9. DeVault KR. Castell DO. Updatedguideliens for the treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190-200:190Available from URL: http://www.gi.org/physicians/guidelines/GERDTreatment.pdf. Accessed March 2008.

Last Updated: April 2008
This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.