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Prokinetics prescribing in paediatrics: evidence on cisapride, domperidone, and metoclopramide
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Mt-Isa, Shahrul, Tomlin, Stephen, Sutcliffe, Alastair, Underwood, Martin, Williamson, Paula, Croft, Nicholas M. and Ashby, Deborah (2015) Prokinetics prescribing in paediatrics: evidence on cisapride, domperidone, and metoclopramide. Journal of Pediatric Gastroenterology and Nutrition, 60 (4). pp. 508-514. doi:10.1097/MPG.0000000000000657 ISSN 0277-2116.
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Official URL: https://doi.org/10.1097/MPG.0000000000000657
Abstract
Objectives: Domperidone and metoclopramide are prokinetics commonly prescribed off-label to infants and younger children in an attempt to treat gastro-oesophageal reflux symptoms. Another prokinetic drug, cisapride, was used but withdrawn in 2000 in the United Kingdom because of serious arrhythmic adverse events. Medicines and Healthcare Products Regulatory Agency issued safety warnings for domperidone in May 2012 and restricted its indications. We report here national primary care prescribing trends and safety signals of these drugs in children.
Methods: We used data from the General Practice Research Database between 1990 and 2006 for children <18 years. Descriptive statistics and Poisson regressions were performed to characterise prescribing trends. We examined safety signals in nested case–control studies.
Results: The proportion of children <2 years old being prescribed one of the medications doubled during the study period. Prescriptions of domperidone increased 10-fold, mainly following the withdrawal of cisapride in 2000. Prescriptions of metoclopramide did not change significantly. Despite the increase in prescriptions of domperidone, no new safety signals were identified.
Conclusions: These data showed dramatic changes in prescribing of cisapride and domperidone despite the lack of good-quality supporting evidence. It is possible that these prescribing trends were influenced by published guidelines. Even if produced without robust efficacy and safety evidence, published guidelines can influence clinicians and consequently affect prescribing. Therefore, improving the evidence base on prokinetics to inform future guidelines is vital. The lack of new safety signals during this period would support the development of suitable powered clinical studies.
| Item Type: | Journal Article | ||||||
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | Journal of Pediatric Gastroenterology and Nutrition | ||||||
| Publisher: | Lippincott Williams & Wilkins | ||||||
| ISSN: | 0277-2116 | ||||||
| Official Date: | April 2015 | ||||||
| Dates: |
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| Volume: | 60 | ||||||
| Number: | 4 | ||||||
| Page Range: | pp. 508-514 | ||||||
| DOI: | 10.1097/MPG.0000000000000657 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) |
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