In 1993 the US Food and Drug Administration approved Cisapride, an oral prokinetic drug, for the symptomatic treatment of nocturnal heartburn due to gastroesophageal reflux disease.
Reports of serious cardiac arrhythmias and deaths during administration of cisapride, most involving concomitant exposure to another drug, were made. Thus, a series of label changes and warnings were issued in February 1995, October 1995, June 1998, and June 1999.
Cisapride was removed from general distribution in July 2000.
| Of 131,485 cisapride prescriptions, 3.4% overlapped with at least one contraindicated drug.|
| Journal of the American Medical Association |
A team from the USA determined the frequency of contraindicted coprescribing and codispensings of cisapride and contraindicated drugs.
The results of the study were published in the latest issue of the Journal of the American Medical Association.
They looked at occasions when cisapride and a contraindicated drug were prescribed or dispensed to the same patient for overlapping periods. In addition, the proportion of contraindicated coprescribing by the same physicians, and codispensing by the same pharmacies, was examined.
The authors retrospectively analyzed prescription claims from a managed care organization database, for all patients with cisapride prescriptions between July 1993 and December 1998.
A total of 38,757 adult and pediatric patients who had a cisapride prescription were identified.
The researchers found that, of 131,485 cisapride prescriptions dispensed after the warnings began, 4414 (3.4%) overlapped with at least 1 drug contraindicated in the labeling at the time of the prescription.
Of all overlapping prescription pairs, 2190 (50%) were by the same physicians, 3908 (89%) were by the same pharmacies, and 765 (17%) were dispensed on the same day.
Dr Judith K. Jones, of the Degge Group, Arlington, Virginia, said on behalf of her colleagues, "Prescriptions dispensed by the same pharmacies accounted for a far higher proportion of contraindicated medication pairs, than prescriptions from the same physicians."
"The pharmacy may be an important and underutilized intervention point to prevent contraindicated drugs from being used together," she concluded.