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Cardiovascular safety of prokinetic agents: A focus on drug‐induced arrhythmias
Author(s) -
Giudicessi J. R.,
Ackerman M. J.,
Camilleri M.
Publication year - 2018
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13302
Subject(s) - cisapride , torsades de pointes , medicine , domperidone , tegaserod , prokinetic agent , qt interval , drug , intensive care medicine , gastroparesis , pharmacology , atrial fibrillation , anesthesia , constipation , cardiology , stomach , gastric emptying , dopamine
Abstract Background Gastrointestinal sensorimotor dysfunction underlies a wide range of esophageal, gastric, and intestinal motility and functional disorders that collectively constitute nearly half of all referrals to gastroenterologists. As a result, substantial effort has been dedicated toward the development of prokinetic agents intended to augment or restore normal gastrointestinal motility. However, the use of several clinically efficacious gastroprokinetic agents, such as cisapride, domperidone, erythromycin, and tegaserod, is associated with unfavorable cardiovascular safety profiles, leading to restrictions in their use. Purpose The purpose of this review is to detail the cellular and molecular mechanisms that lead commonly to drug‐induced cardiac arrhythmias, specifically drug‐induced long QT syndrome, torsades de pointes, and ventricular fibrillation, to examine the cardiovascular safety profiles of several classes of prokinetic agents currently in clinical use, and to explore potential strategies by which the risk of drug‐induced cardiac arrhythmia associated with prokinetic agents and other QT interval prolonging medications can be mitigated successfully.