Cisapride for Dogs – Strongest Prokinetic
Cisapride is the strongest prokinetic available for dogs. Withdrawn from human market due to cardiac arrhythmia (QT prolongation) – compounded for veterinary use.
Dose
0.1-1.0 mg/kg PO every 8 hours – 30 minutes BEFORE meals
Dose by Indication
| Indication | Dose | Frequency |
|---|---|---|
| Gastric stasis | 0.1-0.5 mg/kg | Q8h |
| Megaesophagus | 0.25-0.5 mg/kg | Q8h |
| Constipation/megacolon | 0.5-1 mg/kg | Q8-12h |
| GERD reflux | 0.1-0.5 mg/kg | Q8h |
Mechanism
- 5-HT4 agonist – enhances ACh release from enteric nerves
- 5-HT3 antagonist contributes
- Increases gastric emptying
- Increases intestinal transit
- Increases LES tone
- Increases colonic motility
Stronger Than Other Prokinetics
- More effective than metoclopramide (D2 antagonist)
- More effective than erythromycin (motilin agonist)
- Best option for refractory motility disorders
âš Cardiac Risk
- QT prolongation (reason for human withdrawal)
- Less concerning at veterinary doses
- AVOID with QT-prolonging drugs:
- Sotalol
- Dofetilide
- Fluoroquinolones (additive)
- Consider ECG monitoring in cardiac patients
âš Critical Drug Interactions (CYP3A4 Substrate)
AVOID
- Ketoconazole – dramatically increases levels
- Itraconazole – same
- Erythromycin – same
- Clarithromycin – same
Caution
- Fluconazole (moderate increase)
- Fluoroquinolones (additive QT)
Administration
30 MINUTES BEFORE MEALS – allows drug to reach intestinal site of action.
Side Effects
Generally Well-Tolerated
- Mild GI cramping
- Diarrhea (if excessive dose)
- Hypersalivation
Rare
- Cardiac arrhythmia
- Hyperactivity
Frequently Asked Questions
How much cisapride for my dog?
INDICATION-SPECIFIC: 1) GASTRIC STASIS: 0.1-0.5 mg/kg PO q8h; 2) MEGAESOPHAGUS: 0.25-0.5 mg/kg q8h; 3) CHRONIC CONSTIPATION/MEGACOLON: 0.5-1 mg/kg q8-12h; 4) GERD REFLUX: 0.1-0.5 mg/kg q8h. EXAMPLES (0.5 mg/kg): 1) 5 kg = 2.5 mg; 2) 10 kg = 5 mg; 3) 20 kg = 10 mg; 4) 30 kg = 15 mg. COMPOUNDED ONLY – veterinary compounding pharmacy required (Wedgewood, Diamondback Drugs, etc.). Typical formulations: 5 mg/mL liquid, 5 mg or 10 mg capsules. GIVE 30 MINUTES BEFORE MEALS for prokinetic effect. Q8H schedule for steady-state. WORKS BETTER than metoclopramide or erythromycin for severe motility issues.
Why is cisapride only available compounded?
WITHDRAWN from human market due to cardiac arrhythmia (QT prolongation + torsades de pointes). REGULATORY HISTORY: 1) Withdrawn from US human market in 2000; 2) Cardiac arrhythmias + deaths reported; 3) Risk factor combinations (drug interactions); 4) Limited availability under restricted access for humans. VETERINARY use through COMPOUNDING: 1) Cisapride still effective + useful for severe motility disorders in dogs/cats; 2) Veterinary doses lower than human; 3) Lower cardiac risk in animal patients; 4) Compounding pharmacies have continued production for veterinary patients; 5) AMDUCA regulations permit; 6) Verify pharmacy quality (FDA compliance, reputation). RISK MITIGATION: 1) Use lowest effective dose; 2) Watch for cardiac signs (syncope, weakness); 3) AVOID drug interactions (ketoconazole, itraconazole, erythromycin, fluoroquinolones); 4) Caution in cardiac patients; 5) ECG if cardiac concerns. ALTERNATIVES if cisapride concerns: 1) METOCLOPRAMIDE 0.2-0.5 mg/kg q8h (less effective but available); 2) ERYTHROMYCIN low dose 0.5-1 mg/kg q8h (less effective); 3) BETHANECHOL cholinergic agonist (different mechanism); 4) MOSAPRIDE similar to cisapride (less data); 5) PRUCALOPRIDE 5-HT4 agonist (newer).
What can I give for megaesophagus along with cisapride?
MULTIMODAL approach essential. STANDARD MEGAESOPHAGUS MANAGEMENT: 1) CISAPRIDE 0.25-0.5 mg/kg q8h – 30 min before meals; 2) BAILEY CHAIR feeding upright 10-20 min after meals (gravity assists swallowing); 3) METOCLOPRAMIDE 0.2-0.5 mg/kg q8h (combine for additive prokinetic); 4) SUCRALFATE – protects esophageal mucosa from reflux; 5) OMEPRAZOLE 1 mg/kg q24h – acid suppression; 6) FAMOTIDINE alternative H2 blocker; 7) BETHANECHOL cholinergic agonist (some protocols); 8) Frequent SMALL MEALS (4-6/day); 9) High-calorie density diet (less volume); 10) MEATBALL or slurry consistency varies by dog. UNDERLYING CAUSE workup: 1) MYASTHENIA GRAVIS – Tensilon test; pyridostigmine treatment; 2) HYPOTHYROIDISM – thyroid panel; levothyroxine; 3) ADDISON’S DISEASE – ACTH stim; supplementation; 4) Toxins; 5) Idiopathic. ASPIRATION PNEUMONIA PREVENTION: 1) Major cause of death; 2) Bailey chair feeding; 3) Watch for cough/respiratory signs; 4) Prompt antibiotic treatment; 5) Bordetella vaccine. Veterinary internist consultation valuable for complex cases.
Related PuppaDogs Calculators
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References & Further Reading
The dosing ranges and safety information on this page are drawn from the following veterinary references. Always defer to your own veterinarian and the manufacturer’s label for your specific product.
- Plumb DC. Cisapride.
- Hall JA, Washabau RJ. Gastrointestinal motility disorders.
- Encarnacion HJ et al. Megaesophagus.
- Washabau RJ. Diagnosis and management of GI motility disorders.
- PuppaDogs. Megaesophagus Calculator, Metoclopramide Calculator. puppadogs.com.
