Gasmotin (Mosapride Citrate) Dosing for Cardiac Patients
The standard dose of Gasmotin (mosapride citrate) is 5 mg three times daily, and it appears safe for cardiac patients based on available evidence showing no adverse effects on heart rate, blood pressure, autonomic function, or cardiac conduction. 1, 2
Standard Dosing Protocol
- Adults and children ≥12 years: 5 mg three times daily (conventional-release formulation) 3, 4
- Alternative sustained-release formulation: 15 mg once daily has demonstrated equivalent efficacy 3
- Maximum daily dose: Do not exceed 12 tablets (based on FDA labeling for the formulation) 1
Cardiac Safety Profile
Mosapride demonstrates a favorable cardiac safety profile that distinguishes it from other prokinetic agents:
- No effect on cardiac conduction: Studies show no changes in QT interval or QT dispersion after administration 2
- Hemodynamically neutral: No significant changes in blood pressure or heart rate in healthy volunteers 2
- No autonomic disruption: Spectral analysis of heart rate and blood pressure variability showed no changes in autonomic nervous activity parameters 2
- Mechanism advantage: Unlike cisapride, mosapride does not block potassium channels or dopamine D2 receptors, which reduces cardiac risk 5
Specific Cardiac Considerations
Pre-existing cardiac conditions require standard precautions but are not absolute contraindications:
- Heart disease patients: FDA labeling advises consulting a physician before use in patients with heart disease, but does not contraindicate use 1
- Hypertension: Similar advisory applies—consultation recommended but not prohibited 1
- No drug interactions with cardiac medications: The selective 5-HT4 receptor mechanism minimizes interactions with cardiovascular drugs 2, 5
Contraindications and Warnings
The following conditions warrant caution or avoidance:
- Diabetes: Consult physician before use 1
- Thyroid disease: Consult physician before use 1
- Prostate enlargement with urinary retention: Consult physician before use 1
- MAOI use: Do not use if taking MAOIs or within 2 weeks of stopping MAOI therapy 1
Monitoring Recommendations
For cardiac patients initiating mosapride:
- Monitor for dizziness, nervousness, or sleeplessness—discontinue if these occur 1
- Assess symptom improvement within 7 days; if no improvement or fever develops, discontinue and consult physician 1
- No specific cardiac monitoring (ECG, blood pressure) is required based on the drug's safety profile 2
Clinical Context
The evidence strongly supports mosapride's cardiac safety:
Research in healthy volunteers demonstrated that mosapride increased gastric motility and emptying without influencing autonomic nervous activity, leading investigators to conclude it "may be very useful for elderly patients or patients with autonomic imbalance" 2. This is particularly relevant for cardiac patients who often have autonomic dysfunction or are taking medications that affect autonomic tone.
The drug's selective 5-HT4 agonist mechanism facilitates acetylcholine release from enteric neurons without the cardiac risks associated with older prokinetics like cisapride 5. Studies have shown good tolerability even in vulnerable populations such as Parkinsonian patients, with minimal adverse events and no worsening of cardiovascular parameters 5.
Human pharmacokinetic studies show peak plasma levels occur at 60 minutes post-dose, with effects on gastrointestinal peptides (motilin, gastrin) but no changes in cardiovascular parameters 6.