Abstract
Prokinetic agents are a very large family of drugs with different mechanisms of action. Only QT prolongation by cisapride has made notable impact and deserved its partial restriction and/or withdrawal from the market. Postmarketing surveillance initially showed that cisapride was generally safe and well tolerated, but in the past decade, more recent data have shown some risk in the patient populations. QT prolongation by prokinetic agents can raised from different mechanisms: some involve increased plasma concentrations of cisapride due to increased bioavailability by inhibiting P glycoprotein, and inhibition of metabolism or deficit in the elimination. On the other hand, pharmacodynamic interactions can also enhance the arrhythmogenic effect of cisapride. The present article presents the mechanisms and reviews the main interactions studied so far, and the role of pharmacovigilance in the detection of rare clinical events. We emphasize the need for physicians to look for conditions (either clinical or not) prone to increase the risk of QT interval prolongation.
Keywords: Prokinetic agents, cisapride, mosapride, torsades de pointes, long QT syndrome, pharmacovigilance
Current Drug Safety
Title: Prokinetic Agents and QT Prolongation: A Familiar Scene with New Actors
Volume: 5 Issue: 1
Author(s): Guillermo Alberto Keller and Guillermo Di Girolamo
Affiliation:
Keywords: Prokinetic agents, cisapride, mosapride, torsades de pointes, long QT syndrome, pharmacovigilance
Abstract: Prokinetic agents are a very large family of drugs with different mechanisms of action. Only QT prolongation by cisapride has made notable impact and deserved its partial restriction and/or withdrawal from the market. Postmarketing surveillance initially showed that cisapride was generally safe and well tolerated, but in the past decade, more recent data have shown some risk in the patient populations. QT prolongation by prokinetic agents can raised from different mechanisms: some involve increased plasma concentrations of cisapride due to increased bioavailability by inhibiting P glycoprotein, and inhibition of metabolism or deficit in the elimination. On the other hand, pharmacodynamic interactions can also enhance the arrhythmogenic effect of cisapride. The present article presents the mechanisms and reviews the main interactions studied so far, and the role of pharmacovigilance in the detection of rare clinical events. We emphasize the need for physicians to look for conditions (either clinical or not) prone to increase the risk of QT interval prolongation.
Export Options
About this article
Cite this article as:
Keller Alberto Guillermo and Di Girolamo Guillermo, Prokinetic Agents and QT Prolongation: A Familiar Scene with New Actors, Current Drug Safety 2010; 5 (1) . https://dx.doi.org/10.2174/157488610789869166
DOI https://dx.doi.org/10.2174/157488610789869166 |
Print ISSN 1574-8863 |
Publisher Name Bentham Science Publisher |
Online ISSN 2212-3911 |
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
Related Articles
-
Torsadogenic Cardiotoxicity of Antipsychotic Drugs: a Structural Feature, Potentially Involved in the Interaction with Cardiac HERG Potassium Channels
Current Medicinal Chemistry Promising Anti-Fibrotic Approaches for Future Treatment of Systemic Sclerosis
Current Rheumatology Reviews Benzodiazepine Metabolism: An Analytical Perspective
Current Drug Metabolism Balancing the Risks of Thrombosis and Bleeding Following Transcatheter Aortic Valve Implantation: Current State-of-Evidence
Current Pharmaceutical Design Biological Nitration of Arachidonic Acid
Current Vascular Pharmacology The Spatial QRS-T Angle: Implications in Clinical Practice
Current Cardiology Reviews Device Therapies: New Indications and Future Directions
Current Cardiology Reviews A Combined Approach Using Patch-Clamp Study and Computer Simulation Study for Understanding Long QT Syndrome and TdP in Women
Current Cardiology Reviews Artificial Neural Networks for the Prediction of Response to Interferon Plus Ribavirin Treatment in Patients with Chronic Hepatitis C
Current Pharmaceutical Design Use of Naturally Occurring Peptides for Neuropathic Spinal Cord Injury Pain
Current Protein & Peptide Science Lead Optimization of Melanin Concentrating Hormone Receptor 1 Antagonists with low hERG Channel Activity
Current Topics in Medicinal Chemistry Comprehensive Cardiac Safety Assessment using hiPS-cardiomyocytes (Consortium for Safety Assessment using Human iPS Cells: CSAHi)
Current Pharmaceutical Biotechnology The Role of Molecular Imaging in the Assessment of Cardiac Amyloidosis: State-of-the-Art
Current Radiopharmaceuticals Recent Developments in Antithrombotic Therapy: Will Sodium Warfarin Be a Drug of the Past?
Recent Patents on Cardiovascular Drug Discovery Ethnobotanical Survey of Medicinal Plants used to Treat Cardiovascular Disorders in Ghasemloo Valley of Urmia City
Cardiovascular & Hematological Agents in Medicinal Chemistry Side Effects of AAS Abuse: An Overview
Mini-Reviews in Medicinal Chemistry Kounis Syndrome Following Beta-Lactam Antibiotic Use: Review of Literature
Inflammation & Allergy - Drug Targets (Discontinued) Novel Approaches for Allergy
Current Medicinal Chemistry - Anti-Inflammatory & Anti-Allergy Agents Anesthesia Issues in Central Nervous System Disorders
Current Aging Science Updates on HCN Channels in the Heart: Function, Dysfunction and Pharmacology
Current Drug Targets