Context Cisapride, an oral prokinetic drug indicated for the
symptomatic treatment of nocturnal heartburn due to gastroesophageal
reflux disease, was approved by the US Food and Drug Administration in
July 1993. After reports of serious cardiac arrhythmias and deaths
during administration of cisapride, most involving concomitant exposure
to another drug, a series of label changes and warnings were issued in
February 1995, October 1995, June 1998, and June 1999. Cisapride was
removed from general distribution in July 2000.
Objective To determine the frequency of contraindicted
coprescribing and codispensings, in which cisapride and a
contraindicated drug were prescribed or dispensed to the same patient
for overlapping periods, and the proportion of contraindicated
coprescribing by the same physicians and codispensing by the same
Design and Setting Retrospective study of prescription claims from
a managed care organization database for all patients with cisapride
prescriptions between July 1993 and December 1998.
Participants A total of 38 757 adult and pediatric patients
who had a cisapride prescription immediately preceded by at least 60
days of insurance eligibility.
Main Outcome Measure Proportion of cisapride prescriptions or
dispensing occurring during the same treatment period as a drug
contraindicated at that time prescribed by the same physicians or
dispensed by the same pharmacies.
Results Of 131 485 cisapride prescriptions dispensed after
the warnings began, 4414 (3.4%) overlapped with at least 1 drug
contraindicated in the labeling at the time of the prescription. Of all
overlapping prescription pairs, 2190 (50%) were by the same
physicians, 3908 (89%) were by the same pharmacies, and 765 (17%)
were dispensed on the same day.
Conclusion Prescriptions dispensed by the same pharmacies
accounted for a far higher proportion of contraindicated medication
pairs than prescriptions from the same physicians. The pharmacy may be
an important and underutilized intervention point to prevent
contraindicated drugs from being used together.