Is rectally administered cisapride an effective prokinetic agent?

OBJECTIVE: To summarize the published data on the efficacy of rectally administered cisapride. DATA SOURCES: Published double-blind, placebo-controlled trials on rectally administered cisapride identified by MEDLINE (January 1966-December 1998) and International Pharmaceutical Abstracts (January 1970-December 1998) searches. DATA SYNTHESIS: Cisapride is an oral prokinetic agent that increases lower esophageal sphincter tone, accelerates gastric emptying, and increases small-bowel motility. Clinical trials of rectal cisapride have used both single- and multiple-dosing regimens. Typically, patients received one or two 30-mg suppositories (provided by the manufacturer). Rectal cisapride was effective in enhancing gastric emptying of solid or semisolid meals in healthy patients or patients with chronic gastric emptying disorders. Rectal cisapride was not effective in antagonizing the gastrointestinal effects of narcotic analgesics or promoting the return of small-bowel activity in adults with postoperative ileus. Mixed results were seen when rectal cisapride was used to promote enteral feedings in patients with persistent ileus, CONCLUSIONS: The use of rectal cisapride cannot be recommended at this time. Rectal cisapride was effective only in patients who could have otherwise taken either cisapride tablets or suspension but it was not effective in patients who are physically unable to swallow or restricted from ingesting anything orally following surgical procedures. Considering the varied patient populations and evaluation methods used in these studies, the lack of a commercially available cisapride suppository, and absence of studies involving extemporaneously prepared cisapride suppositories, the use of suppositories should be limited to investigational trials.