Home About SPA Join SPA Education Newsletter Jobs & Fellowships Volunteer Service Abroad Links of Interest

SPA Newsletter

.

Stolberg S. NY Times March 24, 2000

Review: The report refers to off-label prescription of this heartburn medication for more serious conditions . The only reference to children is part of one sentence near the end of the article which indicates that the medication is prescribed for children as a treatment for constipation.

Comments: After finishing this group of articles, I began to look for Alice and the White Rabbit. At first, I was unclear why a medication which was helpful to children and which was carefully evaluated and then endorsed by two scientific societies would be made unavailable.

This is an interesting vignette of money in action (the drug companies decision to cut their losses) with no evidence of real concern for the health of children, some of whom have benefited from treatment with this cisapride. Children are once again marginalized by the health care system. This medication, which two major pediatric GI societies reported as being useful as a treatment for GER, was mentioned only as having been used to treat constipation in children. Two gastroenterologists with whom I spoke here agreed and indicated that the medication was useful in treatment of children with GER even though its use as such was off-label. These pediatricians both thought that the company was acting to limit its liability and that the risk posed by cisapride was not excessive. It strikes me that the risk of arrthymias posed by tricyclic antidepressants may be similar to if not greater than that posed by cisapride. With precautions, tricyclics are used with regularity in both children and adults. Cisapride may no longer be used as part of anti-reflux treatment, but the report in the Times left open the possibility that some patients will still be able to receive the medication.

Reviewed by: Thomas J. Mancuso, MD, FAAP
Childrens Hospital, Boston