Macrolides Cisapride

Hypersensitivity to any of the macrolide antibiotics patients receiving cisapride or pimozide known, suspected, or potential bacteremias (dirithromycin) preexisting liver disease (erythromycin estolate). 

A history of hypersensitivity to telithromycin and/or any components of the product or any macrolide antibiotic. Coadministration of telithromycin with cisapride or pimozide is contraindicated. 

Drugs that may affect tacrolimus include nephrotoxic agents (aminoglycosides, amphotericin B, cisplatin, cyclosporine), antifungals, bromocriptine, calcium channel blockers, cimetidine, clarithromycin, danazol, diltiazem, erythromycin, methylprednisolone, metoclopramide, carbamazepine, phenobarbital, phenytoin, rifamycins, cisapride, chloramphenicol, metronidazole, nefazodone, omeprazole, protease inhibitors, macrolide antibiotics, fosphenytoin, and St. John s wort. 

Others Acetaminophen, amiodarone, carbamazepine, delavirdine, efavirenz, nevirapine, quinidine, repaglinide, sildenafil, tadalafil, trazodone, vardenafil Amiodarone, amprenavir, atazanavir, ciprofloxacin, cisapride, clarithromycin, diltiozem, erythromycin, fluconazole, fluvoxamine, grapefruit juice (in high ingestion), indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, norfloxacin, ritonavir, telithromycin, troleandomycin, verapamil, voriconazole Carbamazepine, efavirenz, glucocorticoids, macrolide antibiotics, nevirapine, phenytoin, phenobarbital, rifabutin, rifapentine, rifampin, St. John s wort... 

Due to prokinetic effects in the colon, abdominal cramps and diarrhea occur in up to 15% of patients taking cisapride however significant problems are unusual. In addition, cisapride is metabolized by the hepatic cytochrome P450 CYP3 A4 enzyme. When coadministered with drugs that inhibit this enzyme (such as ketoconazole, fluconazole, macrolide antibiotics, and HIV protease inhibitors), significant increases in serum levels of cisapride may occur that rarely lead to QT prolongation on the ECG and serious cardiac arrhythmias. For this reason, cisapride was removed... 

The use of cisapride and its benefit to harm balance in children has been reviewed (25). Overall it is well tolerated. The most common adverse effects are diarrhea, abdominal cramps, borborygmi, and colic. Serious adverse events are rare and include isolated cases of extrapyramidal reactions, seizures in epileptic patients, cholestasis, QT interval prolongation and ventricular dysrhythmias, anorexia, and enuresis. Interactions of cisapride with other drugs are similar to those reported in adults. Co-administration of drugs that inhibit CYP3A4, such as imidazoles, macrolide antibiotics, the antidepressant nefazodone, and protease inhibitors such as ritonavir, are contraindicated. Furthermore, co-administration of anticholinergic drugs can compromise the beneficial effects of cisapride. 

Cisapride 10 mg t.i.d. 20 mg q.i.d. 5% 100% 100% 50%- 75% Avoid with azole antifungal agents, macrolide antibiotics, and other P450 3A-4 inhibitors... 

Cisapride 10 mg po tid 20 mg qid 5% 100% 100% 50-75% Avoid with Azole Antifungal, Macrolide antibiotics and other P450 IIIA-4 inhibitors... 

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