Cisapride in Constipation

To the Editor: I. M. Halabi showed that cisapride may be helpful in the management of chronic idiopathic constipation in children (1). However, cisapride should not be recommended as a first-line approach in paediatric constipation. Prokinetics, or drug treatment in general, should only be recommended after failure of behavioral (physical activity) and dietary changes (Fluid, fiber, fruit) (2). Moreover, the dose of cisapride used in the study by Halabi (1.2 mg/kg/day) is 50% above the recommended safe dose of 0.8 mg/kg per day (3). If cisapride is prescribed in a dose higher than the recommended 0.8 mg/kg per day, safety procedures such as an electrocardiogram 48 to 72 hours after initiation of cisapride at a higher dose should be performed (3). Yvan Vandenplas AZ-VUB, Laarbeeklaan Brussels, Belgium