Cisapride and ranitidine in the treatment of gastro-oesophageal reflux disease--a comparative randomized double-blind trial.

Forty patients with gastro-oesophageal reflux disease and oesophagitis, documented by endoscopy (grades I to III by the Savary-Miller classification) were randomized to participate in a comparative double-blind trial to receive cisapride (10 mg q.d.s.) or ranitidine (150 mg b.d.) for an 8-week period. Upper gastrointestinal endoscopy was performed immediately before the entry to the trial and after the 8-week period at the completion of the trial. The evaluable cohort included 37 patients who completed the trial, 18 in the cisapride group and 19 in the ranitidine group. Three patients were withdrawn from the trial; one on ranitidine developed severe anaphylactic reaction, one on cisapride severe dizziness and one on cisapride did not wish to continue on the trial. The results of the trial, regarding symptomatic and endoscopic improvement were comparable in the two groups. Both drugs were effective in controlling symptoms, such as acid regurgitation, retrosternal pain, retrosternal burning, epigastric fullness and discomfort (pain, burning, sense of pressure) and resulted in endoscopic healing of oesophagitis. With few exceptions, symptoms remained in remission 1 month after treatment in the majority of patients. Globally, both drugs were tolerated comparably, and adverse effects other than those which resulted in the withdrawal from the trial were minimal in both groups. The results of this trial indicate that cisapride and ranitidine, although of different pharmacological action, are comparable in their therapeutic effect in symptomatic improvement and endoscopic healing in patients with mild to moderate gastro-oesophageal reflux disease.

Chronic or recurrent vaginal candidosis: short-term treatment and prophylaxis with itraconazole.

Twenty-one women (mean age, 35.3 years) with 2 to 4 episodes of vaginal candidosis in the last 6 months were included in the study to evaluate the efficacy and safety of itraconazole as short-term, as well as prophylactic, treatment of chronic candidosis. After clinical evaluation and laboratory confirmation of candidosis, 200 mg of itraconazole were given orally for 3 days. Twelve of the 21 patients were cured. The remaining nine repeated treatment, after which all were cured. All patients were entered in the maintenance phase, and received 200 mg of itraconazole the first day of the menstrual cycle for 6 months. One patient relapsed in the second month, but after taking 200 mg of itraconazole BID for 1 day she remained cured for the rest of the study period. All other patients remained cured for the 6 months of the maintenance period. Three months after the end of prophylactic therapy, 17 of 20 patients (85%) were clinically and mycologically cured. No adverse experiences were reported. It is concluded that itraconazole is an efficient and safe short-term treatment for chronic or recurrent vaginal candidosis. Moreover, the dose of 200 mg once monthly for 6 months proved to be a successful suppressive treatment.

Cisapride, metoclopramide, and ranitidine in the treatment of severe nonulcer dyspepsia.

Cisapride, a prokinetic drug with a novel mechanism of action, was compared with another prokinetic drug, metoclopramide, and an H2-blocker, ranitidine, in the treatment of nonulcer dyspepsia. In a double-blind study, 60 patients with severe dyspeptic symptoms received cisapride 5 mg TID, metoclopramide 10 mg TID, or ranitidine 150 mg BID for 8 weeks. Symptoms were evaluated during treatment and 4 weeks after the end of therapy. All three drugs effectively controlled the symptoms of chronic functional upper gastrointestinal tract disorders. The prokinetic drugs, particularly cisapride, were significantly better than ranitidine in controlling symptoms, especially reflux symptoms. All three drugs were generally well tolerated; cisapride in particular was associated with fewer adverse effects.

Effect of chronic ethanol treatment on adenylate cyclase activity in rat striatum.

Chronic ethanol consumption induces an increase in striatal adenylate cyclase enzymatic activity but is unable to further potentiate the dopamine stimulated production of cyclic-AMP. In striatal membranes obtained from chronic ethanol-treated rats, apomorphine exerts a more potent inhibition of [3H]spiperone binding when compared with controls, demonstrating that ethanol increases the affinity of the dopaminergic receptors associated with adenylate cyclase activity. In addition, GTP is unable to modify the agonist component of dopamine receptor in membrane exposed 'in vivo' to ethanol. Data are discussed in terms of a derangement of receptor-adenylate cyclase coupling system produced by chronic ethanol treatment.