Cisapride for Cats

Cats who suffer from a variety of gastrointestinal (GI) disorders may benefit from regular use of cisapride, a medication that can help your cat manage GI ailments such as chronic constipation or megacolon. If other treatment options have failed to fully improve your cat’s gut health, talk with your veterinarian about the use of cisapride.

What follows is everything you need to know about cisapride, including what it’s used for in cats, potential side effects, and how to give this medication.

What Is Cisapride?

Cisapride is a gastrointestinal promotility (or prokinetic) drug, which means it helps move ingested food (and later feces) in the right direction—downward through the GI tract.

Cisapride is a generic medication that can only be obtained via a prescription from your veterinarian. It was originally available for human usage but was withdrawn from the regular market in 2000 due to potentially fatal cardiac complications. In people, cisapride can prolong the QT interval in the heart, meaning electrical activity of the heart becomes irregular and can progress to abnormal heart rhythms (ventricular arrhythmias) that can cause fainting (syncope) and sudden death.

Fortunately, such cardiac issues from cisapride use appear to be extremely rare in dogs and cats and have not been documented by the veterinary community. However, since cisapride no longer has FDA approval, it is not commercially available in North America. It must be purchased solely from your regular vet or compounding pharmacy as a generic drug with “off-label” use in dogs and cats. 

Is Cisapride Safe for Cats?

Cisapride is considered an overall safe medication in the majority of cats when used at a proper dosage as recommended by a veterinarian.

What Does Cisapride for Cats Look Like?

Since cisapride is available only in compounded form, it may be formulated in a variety of ways. Cisapride is primarily available in oral form as a flavored or unflavored liquid, capsule, or tablet. Tablets may be regular, chewable, mini-tabs, or melt tabs. Some compounding pharmacies may also make cisapride in a transdermal gel that is applied topically. However, oral forms tend to be more effective, as they are more readily absorbed by the body.

How Does Cisapride Work?

Normally, smooth muscles automatically contract to push food downward through the digestive tract; this is referred to as peristalsis. However, some cats have disorders that slow the movement of gut activity, leading to impaired GI function. Cisapride acts directly on the stomach, small intestine, and large intestine (colon) to speed the transit of ingested food through the GI tract and facilitates defecation. It also increases peristalsis in the lower esophagus to help prevent reflux.

In short, cisapride keeps the GI tract moving in the right direction, helping cats avoid issues like chronic constipation and fecal impaction. 

Cisapride is a relative of a medication called metoclopramide. However, cisapride is considered superior because it works on the colon, whereas metoclopramide has no colonic influence. Additionally, metoclopramide can cross over into the brain and cause hyperexcitability. Cisapride does not cross the blood-brain barrier.

What Is Cisapride Used for in Cats?

As discussed earlier, Cisapride’s primary use is to keep the gut moving at a normal speed in the right direction by enhancing smooth muscle function. Thus, it is useful for a variety of medical conditions in cats such as:

• Esophagitis (inflammation of the esophagus)
• Primary gastric stasis disorders (e.g., delayed gastric emptying, intestinal ileus)
• Chronic constipation (difficulty passing stool) and bloating
• Megacolon
• Certain urinary retention disorders
• Occasionally for hairball issues

Read on for further explanation on how cisapride can help cats with these issues:

Esophagitis

Cisapride reduces esophageal reflux and risk of esophageal stricture formation.

Primary gastric stasis disorders

Examples of primary gastric stasis disorders in cats include delayed gastric emptying and intestinal ileus. 

Delayed gastric emptying: This condition occurs when the muscles and nerves of the stomach do not cause normal contractions to move ingested food out of the stomach and into the small intestine for further processing. Delayed gastric emptying can lead to chronic vomiting.

Intestinal ileus: This refers to a lack of motility primarily of the small intestine.

Though cisapride can help minimize vomiting from these disorders by preventing food from backing up in the stomach, pet parents should note that cisapride does not have further anti-nausea properties. It should not be used as an anti-emetic substitute for other instances that trigger nausea in cats.

Chronic constipation and bloating

If diet changes, stool softeners or laxatives, and bulking agents such as fiber supplements have failed to improve your cat’s constipation issues, your vet may add cisapride as a mode to further improve the ease of your cat’s bowel movements.

Megacolon

This disorder results from impairment of the muscles and nerves that control bowel function. Megacolon is secondary to damage from stretching of the colon due to chronic constipation or fecal obstruction (i.e. obstipation). Megacolon prevents the colon from emptying stool, which can lead to difficulty defecating and bowel obstruction.

Certain urinary retention disorders

Cisapride can help strengthen bladder muscle contraction to facilitate urine voiding.

Hairballs

Cisapride is also occasionally used for hairball issues in cats.

How to Give Cisapride to Cats

As mentioned, Cisparide is available in multiple formulas, such as soft chews, capsules, tablets, and liquids. Your cat may have a unique preference as to which medication formulation they will most easily tolerate. Some cats are easy to give tablets or capsules while others may more readily accept a syringe of liquid medication instead. Some cats may prefer a flavored medication, such as tuna. Ask your compounding pharmacy what varieties are available.

Cisapride is typically administered every 8-12 hours, depending on your vet’s instructions. Though cisapride can be given with or without food, it is best to give it 15-30 minutes prior to a meal, since absorption improves with food. Furthermore, food reduces the likelihood of GI upset as a potential side effect from this medication.

Cats will experience results within a few hours following dosing, and those effects will cease within 24 hours of discontinuation of this drug.

Cisapride for Cats Side Effects

Luckily, cisapride is generally well tolerated with minimal side effects in cats, including those with kidney disease. However, some kitties may experience mild GI symptoms such as:

• Vomiting
• Diarrhea
• Abdominal discomfort from cramping

Cisapride should be avoided if increased gastrointestinal motility can lead to harm of the GI tract due to preexisting conditions, which include:

• Intestinal or bowel obstruction: Using cisapride amid a GI blockage can lead to perforation, which can be deadly. Your vet will perform a physical exam and perhaps abdominal radiographs (X-rays) to ensure no blockage is present when cisapride is first prescribed.
• An existing GI perforation
• GI hemorrhage (bright red or dark stool)
• Severe hepatic insufficiency (liver disease): Your vet may recommend to reduce the dose of cisapride by half or avoid use altogether in cats with liver disorders.

Furthermore, cisapride should be used with caution in pregnant or nursing cats. Cisapride has the potential to cause loss of early pregnancy. This drug is also excreted in milk and could potentially cause issues in kittens. Cisapride should only be used in these scenarios if its benefit to the female cat outweighs any potential risk to her kittens.

Moreover, dangerous cardiac effects of cisapride have been established in humans. Though not observed in cats, cats using cisapride should still be monitored for any cardiac abnormalities as a precaution.

Symptoms of Too Much Cisapride in Cats

Toxicity in cats is rare and tends to only occur at extremely high doses of cisapride. Worrisome signs include:

• Diarrhea
• Lethargy
• Uncoordinated, “drunken” movement of the limbs (ataxia)
• Drooling (hypersalivation)
• Muscle tremors (fasciculations)
• Agitation and abnormal behavior
• High body temperature (hyperthermia)
• Difficulty breathing
• Seizures

If you observe the above signs in your cat or suspect they may have been exposed to an overdose of cisapride, call your vet without delay or the ASPCA Animal Poison Control Center at 888-426-4435.

If poisoning has occurred, your vet may recommend to induce vomiting and administer activated charcoal as well as provide supportive care to manage symptoms.

Reactions with Other Drugs and Medications

Because of cisapride’s effect at speeding up the transit time through the gut, it can increase the absorption of other oral medications your cat may be taking. Always go over your cat’s full list of medications and supplements with your veterinarian prior to starting cisapride.

Cisapride can interact negatively with certain medications, such as those listed below. Therefore, concurrent use should be avoided and discussed with your vet:

• Anticholinergic agents, such as atropine
• Benzodiazepines, such as injectable diazepam or midazolam: can worsen sedation effects
• Certain antihistamines/antacids, such as famotidine, cimetidine, and ranitidine
• Anticoagulants
• Cyclosporine
• Furosemide
• Ondansetron
• Opioids
• Some fluoroquinolone antibiotics
• Silymarin (milk thistle)
• Antifungals, such as itraconazole or ketoconazole
• Chloramphenicol
• Some macrolide antibiotics, except azithromycin
• Some cardiac medications, such as amiodarone or sotalol
• Tricyclic antidepressants, such as amitriptyline

Cisapride Dose for Cats

Only your vet should direct you as to the exact dose and frequency of cisapride your cat should receive. Each individual cat is different based on a variety of factors, such as the cat’s weight and exact GI disorder and its severity.

Your cat’s cisapride dose may need to be gradually increased or otherwise modified by your vet to optimize its effect. However, pet parents should never adjust their cat’s dose on their own without a vet’s guidance.

What If My Cat Misses a Dose of Cisapride?

If your cat accidentally misses a dose of cisapride, simply wait and give it when the next dose is due and resume the prescribed protocol moving forward. Do not double up or give additional doses not prescribed by your vet.

Cost of Cisapride for Cats

The cost of cisapride varies widely depending on your cat’s dosage (milligrams needed as well as frequency), the formulation you choose from your compounding pharmacy, as well as your geographic location. On average, you can expect to pay $45-$80 for a 30-day supply of your cat’s cisapride based on the aforementioned variables.

Cisapride Storage Instructions

Cisapride should be protected from light and moisture in a tight, sealed container. Unless specified otherwise on your compounded product, this medication should be stored at room temperature.