Diagnosis and treatment of gastroesophageal reflux disease in infants and children

Table 2 Contraindications and risk factors for use of cisapride

Contraindications to cisapride administ ration in pediatric patients
-Combination with medication also known to prolong the QT interval or potent CYP3A4 inhibitors, such as astemizole, fluconazole,
itraconazole, ketoconazole, miconazole, eythromycin, clarithromycin, troleandomycin, nefazodone, indinavir, ritonavir, josamycin,
diphemanil, terfaridine.
-Use of the above medications by a breast-feeding mother, as secretion i n mother's milk of most of these drugs is unknown.
-Known hypersensitivity to cisapride.
-Known congenital long QT syndrome or known idiopathic QT prolongation.
Precautions for cisapride administration in pediatric patients
-Prematurity (a starting dose of 0.1 mg/kg, 4 times daily may be used, although 0.2 mg/kg is also for prematures the normal dose)
-Hepatic or renal failure (particularly when on chronic dialysis). In these cases, it is recommended to start with 50% of the
recommended dose.
-Uncorrected electrolyte disturbances (hypokalemia, hypomagnesemia, hypocal cemia), as may occur in prematures,
in severe diarrhea, in treatment with potassium-wasting diuretics such as furosemide or acetazolamide.
-History of significant cardiac disease including serious ventricular arrhythmia, second or third degree antrioventricular block, congestive heart failure or ischaemic
heart disease, QT prolongation associated with diabetes mellitus.
-History of sudden infant death in a sibling, and/or history of a “serious ” apparent life threatening event in the infant or a sibling.
-Intracranial abnormalities, such as encephalitis or haemorrhage, grape fruit juice.