PROPULSID QUICKSOLV

Clinical safety rating: caution

Comprehensive clinical and safety monograph for PROPULSID QUICKSOLV (PROPULSID QUICKSOLV).

How it works

Selective serotonin 5-HT4 receptor agonist; enhances release of acetylcholine in the enteric nervous system, increasing gastrointestinal motility without increasing gastric acid secretion.

What the body does with it

Metabolism	Extensively metabolized via CYP3A4; also metabolized by CYP2C8 and CYP2C9. Main metabolites: norcisapride (active) and others.
Excretion	Approximately 60-70% of a dose is excreted in urine as unchanged drug and metabolites; ~30% in feces via biliary excretion.
Half-life	Terminal elimination half-life is approximately 6–12 hours in adults; prolonged in hepatic impairment (up to 20–30 hours) and elderly.
Protein binding	97–98% bound to plasma proteins, primarily albumin.
Volume of Distribution	Vd ≈ 2–4 L/kg (large, indicating extensive tissue distribution).
Bioavailability	Oral bioavailability is 40–50% due to first-pass metabolism; approximately 70% for the oral disintegrating tablet formulation.
Onset of Action	Oral (tablet or suspension): 30–60 minutes; oral disintegrating tablet (Quicksolv): 15–30 minutes.
Duration of Action	Duration of prokinetic effect is 8–12 hours; clinical effects on gastric emptying last up to 4–6 hours after single dose.

Classification & Brands

Dosing & administration

10 mg orally three times daily before meals. Maximum 20 mg per dose.

Dosage form	TABLET, ORALLY DISINTEGRATING
Renal impairment	For GFR <40 mL/min: reduce dose to 5 mg three times daily. No adjustment for GFR ≥40 mL/min.
Liver impairment	Child-Pugh Class A: no adjustment. Child-Pugh Class B: 5 mg twice daily. Child-Pugh Class C: contraindicated.
Pediatric use	Not recommended for children due to risk of serious arrhythmias.
Geriatric use	Start at 5 mg three times daily and titrate cautiously due to decreased metabolism and increased risk of QT prolongation.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for PROPULSID QUICKSOLV (PROPULSID QUICKSOLV).

Breastfeeding	Present in human milk. Milk-to-plasma ratio (M/P) not established. Use with caution due to potential for cardiac effects in the infant, including QT prolongation. Monitor infant for arrhythmias, diarrhea, and extrapyramidal symptoms. Consider alternative with better safety profile.
Teratogenic Risk	First trimester: Human data limited but no increased risk of major malformations in case series. Animal studies show no teratogenicity at clinically relevant doses. Second and third trimesters: No known fetal risk; used for gastroparesis in pregnancy without reported adverse outcomes. However, theoretical risk of QT prolongation exists due to cisapride's proarrhythmic potential.

Warnings & precautions

■ FDA Black Box Warning

Cisapride is associated with serious cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation, torsade de pointes, and QT prolongation. Use is contraindicated with certain drugs and medical conditions that increase risk of arrhythmias.

Side Effect Profile

Serious Effects

Absolute Contraindications

Concomitant use of CYP3A4 inhibitors (e.g., macrolide antibiotics, azole antifungals, protease inhibitors, nefazodone); history of QT prolongation; uncorrected electrolyte disorders; significant bradycardia; concurrent use of other QT-prolonging drugs; known hypersensitivity.

Clinical Precautions

Precautions

Risk of QT prolongation and serious arrhythmias; hypokalemia, hypomagnesemia, bradycardia, and concomitant use of QT-prolonging drugs increase risk. Avoid in patients with structural heart disease. May cause extrapyramidal effects and diarrhea.

Clinical Tips & Counseling

Drug interactions

Loading safety data…

PROPULSID QUICKSOLV

Clinical safety rating: caution

Comprehensive clinical and safety monograph for PROPULSID QUICKSOLV (PROPULSID QUICKSOLV).

How it works

Selective serotonin 5-HT4 receptor agonist; enhances release of acetylcholine in the enteric nervous system, increasing gastrointestinal motility without increasing gastric acid secretion.

What the body does with it

Metabolism	Extensively metabolized via CYP3A4; also metabolized by CYP2C8 and CYP2C9. Main metabolites: norcisapride (active) and others.
Excretion	Approximately 60-70% of a dose is excreted in urine as unchanged drug and metabolites; ~30% in feces via biliary excretion.
Half-life	Terminal elimination half-life is approximately 6–12 hours in adults; prolonged in hepatic impairment (up to 20–30 hours) and elderly.
Protein binding	97–98% bound to plasma proteins, primarily albumin.
Volume of Distribution	Vd ≈ 2–4 L/kg (large, indicating extensive tissue distribution).
Bioavailability	Oral bioavailability is 40–50% due to first-pass metabolism; approximately 70% for the oral disintegrating tablet formulation.
Onset of Action	Oral (tablet or suspension): 30–60 minutes; oral disintegrating tablet (Quicksolv): 15–30 minutes.
Duration of Action	Duration of prokinetic effect is 8–12 hours; clinical effects on gastric emptying last up to 4–6 hours after single dose.

Classification & Brands

Dosing & administration

10 mg orally three times daily before meals. Maximum 20 mg per dose.

Dosage form	TABLET, ORALLY DISINTEGRATING
Renal impairment	For GFR <40 mL/min: reduce dose to 5 mg three times daily. No adjustment for GFR ≥40 mL/min.
Liver impairment	Child-Pugh Class A: no adjustment. Child-Pugh Class B: 5 mg twice daily. Child-Pugh Class C: contraindicated.
Pediatric use	Not recommended for children due to risk of serious arrhythmias.
Geriatric use	Start at 5 mg three times daily and titrate cautiously due to decreased metabolism and increased risk of QT prolongation.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for PROPULSID QUICKSOLV (PROPULSID QUICKSOLV).

Breastfeeding	Present in human milk. Milk-to-plasma ratio (M/P) not established. Use with caution due to potential for cardiac effects in the infant, including QT prolongation. Monitor infant for arrhythmias, diarrhea, and extrapyramidal symptoms. Consider alternative with better safety profile.
Teratogenic Risk	First trimester: Human data limited but no increased risk of major malformations in case series. Animal studies show no teratogenicity at clinically relevant doses. Second and third trimesters: No known fetal risk; used for gastroparesis in pregnancy without reported adverse outcomes. However, theoretical risk of QT prolongation exists due to cisapride's proarrhythmic potential.