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About Propulsid prescribed along with asthma medications

Propulsid (cisapride)
Manufacturer: Janssen Pharmaceutica
Treatment Class: Gastrointestinal
Indication: Gastroesophageal reflux disease

Question: What can you tell me about Propulsid prescribed along with asthma medications?

I have been prescribed propulsid (10mg 15 minutes before meals and bed) and prevacid (20 mg once a day – am) by my allergist. I have been having difficulty with extrinisic asthma for a number of years. Although I am currently taking Seldane D, Serevent Inhaler, Proventil Inhaler, Aerobid Inhaler, and Beconase AQ Nasel Spray as well as receiving allergy shots, my condition has not improved. There are indications that GE reflux may be inhibiting my improvement by causing tightness in my chest, making it difficult for me to breathing difficult. I would like to have information on this course of treatment in asthma sufferers. Also, are there any side-effects that I need to watch out for? Will these medications interfere with any other medications that I am currently on? What medications should I avoid if I should become ill and be prescribed additional medication? Finally, is there another way that I could address these problems without all this medication?

Answer: Many of the answers to your questions can be found in the Understanding GERD pamphlet put out by the American College of Gastroenterology. Especially, see atypical manifestations of gastroesophageal reflux disease.

It has only recently been recognized (in the few years) that GERD can cause symptoms other than Hearburn – ASTHMA being not at all that unusual.

Regarding the interactions with any meds you are taking – I assume that your list includes all medications you are using – so here a few basic comments – but it is mandatory that you consult with your prescribing physicians about this:

1. PREVACID: this medication can cause small changes in the blood levels of theophyllines (one of the types of meds used to treat Asthma); although these changes are small some physicians do recommend checking theophylline levels when a patient begins or stops Prevacid. None of the meds you are presently using contain theophylline however.

2. PROPULSID: There are some drug-drug interactions between Propulsid and certain other meds. The “dear doctor/pharmacist” letter that came out in February advises that ketoconazole is contraindicated with cisapride and that IV miconazole, TAO and one other drug are suggested to be avoided with cisapride. It may also be reasonable to avoid erythromycin, clarithromycin and fluconazole. A You should also be aware that Propulsid can affect how other meds work as well, such as Coumadin & Tagamet.

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