Cisapride: veterinary dose and monograph

At a glance

Drug class

Gastrointestinal

Also known as

Prepulsid, Propulsid, Cisapride monohydrate

Species with doses

Dogs, Cats, Rabbits, Guinea pigs and Chinchillas

General dose range

0.1–0.5 mg/kg PO q8–12h — check the species tables for the indication

Routes

PO

Last reviewed

1 October 2026

Indications

• Feline idiopathic megacolon / chronic constipation (mainstay)
• Gastric stasis / delayed gastric emptying
• Post-operative or functional ileus
• Gastro-oesophageal reflux (increases lower-oesophageal-sphincter tone and gastric emptying)

Cisapride dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

• Gastric stasis / ileus / reflux: Papich 5e: 0.1–0.5 mg/kg q8–12h PO (up to 0.5–1 mg/kg). Plumb’s p.278: 0.1–0.5 mg/kg PO two to three times daily 30 min before meals (Twedt 2008); megaoesophagus 0.55 mg/kg once to three times daily; oesophagitis 0.5–0.75 mg/kg three times daily.

Cats

• Megacolon / constipation: Papich 5e: 2.5–5 mg per cat q8–12h PO (up to 1 mg/kg q8h). Plumb’s p.278: 2.5 mg (cats up to 10 lb) or 5 mg (over 10 lb) three times daily, 7.5 mg in cats over 16 lb (Tams); 2.5–5 mg q8–12h (Carr). Halve the dose in hepatic insufficiency. Combine with lactulose and fibre. (The previous 0.1–0.5 mg/kg under-dosed most cats.)

Rabbits

• GI stasis (no obstruction): Plumb’s p.278: rabbits 0.5 mg/kg PO q6–12h with fluids and high-fibre slurry (Hess 2002; Lichtenberger 2008). Rule out obstruction first.

Guinea pigs

• Ileus (no obstruction): Plumb’s p.278: 0.1–0.5 mg/kg PO q12h (Adamcak & Otten 2000); guinea pigs and chinchillas 0.5 mg/kg q8–12h (Orcutt 2005).

Chinchillas

• Ileus (no obstruction): Plumb’s p.278: 0.1–0.5 mg/kg PO q12h (Adamcak & Otten 2000); 0.5 mg/kg q8–12h (Orcutt 2005).

Contraindications

GI obstruction, perforation or haemorrhage (never give a prokinetic into a mechanical obstruction). Pre-existing QT prolongation/serious arrhythmia. Concurrent potent CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, clarithromycin) — raise cisapride levels and arrhythmia risk. Known hypersensitivity.

Species-specific warnings

Cats: Confirm there is no obstructing colonic mass/foreign body before using a prokinetic; pair with hydration and stool softeners for megacolon.

Adverse effects

• Abdominal cramping, diarrhoea (excess motility)
• Vomiting
• QT prolongation / arrhythmia (high doses or with interacting drugs)
• Rarely sedation/behavioural change

Drug interactions

• CYP3A4 inhibitors (azole antifungals, macrolides): raise cisapride levels → QT prolongation/arrhythmia — avoid combination
• Other QT-prolonging drugs (sotalol, some antiarrhythmics): additive arrhythmia risk
• Anticholinergics (atropine): antagonise the prokinetic effect
• Drugs altering gut pH/absorption: cisapride can change their absorption by speeding transit

Pregnancy and lactation

Limited data; use only if clearly needed. Generally avoided in pregnancy without strong indication.

Monitoring

• Stool frequency/consistency and colon size (megacolon response)
• GI tolerance (cramping/diarrhoea)
• ECG if high doses, cardiac disease, or interacting drugs are involved
• Review co-medications for CYP3A4 inhibitors

Toxicity and overdose

At veterinary doses serious toxicity is uncommon; overdose can cause GI cramping/diarrhoea and, importantly, dose- or interaction-dependent QT prolongation with the potential for ventricular arrhythmia (the reason for its human withdrawal). Risk rises sharply with CYP3A4-inhibitor co-administration.

Management: No specific antidote. Decontaminate if a large recent ingestion; provide supportive GI care. Obtain an ECG and monitor for QT prolongation/arrhythmia — treat ventricular arrhythmia conventionally (correct electrolytes, IV magnesium for torsades, antiarrhythmics as indicated). Discontinue any interacting CYP3A4 inhibitor.

Clinical pearls

• The single most useful drug for feline megacolon — combine with lactulose, fibre/diet, and aggressive hydration
• Works on the colon (unlike metoclopramide), which is exactly why it succeeds in constipation/megacolon
• Give 15–30 minutes before feeding for best prokinetic effect
• Never use into a suspected obstruction, and avoid azole antifungals/macrolides concurrently (QT risk)
• Now a compounded medication — source from a reputable compounding pharmacy

Mechanism of action

A serotonergic prokinetic: it stimulates 5-HT4 receptors on enteric (myenteric-plexus) neurons, enhancing acetylcholine release and producing coordinated, propulsive smooth-muscle contractions from the oesophagus through the colon. Unlike metoclopramide it works along the entire gut (including the colon — key for megacolon) and has no central antidopaminergic/anti-emetic action. Its hERG/IKr potassium-channel block underlies the QT risk seen in people.

Formulations and products

• 5 mg tablet (compounded/specialist)
• 10 mg tablet
• Compounded oral suspension (e.g. 5 mg/mL)
• Cisapride (compounded) (Compounding pharmacy) — Custom (e.g. 2.5 / 5 mg capsule or 5 mg/mL suspension), Compounded capsule/suspension
• Prepulsid (withdrawn) — 5 / 10 mg tablet, Tablet (human-label)

Storage

Compounded tablets/suspension: per compounding pharmacy instructions (often refrigerated suspension); 15–30 °C for tablets, protected from light and moisture.

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

Other gastrointestinal drugs

• Apomorphine
• Bismuth Subsalicylate
• Capromorelin
• Cimetidine
• Famotidine
• Hyoscine Butylbromide (N-Butylscopolammonium)
• Lactulose
• Loperamide

Frequently asked questions