Mosapride Citrate Dosing
The standard adult dose of mosapride citrate is 5 mg three times daily before meals for functional dyspepsia, chronic gastritis, gastro-oesophageal reflux disease, or gastroparesis. 1, 2, 3
Standard Dosing Regimen
Administer 5 mg three times daily (TID) before each meal for all approved gastrointestinal indications including functional dyspepsia, chronic gastritis, GERD, and gastroparesis 1, 2, 3
Treatment duration should be 4 weeks minimum to assess therapeutic response, with symptom assessment performed at the end of this period 2, 3
Higher doses (10 mg twice daily or 7.5 mg three times daily) showed no additional benefit over 5 mg TID in controlled trials, making dose escalation unnecessary 4
Clinical Positioning in Treatment Algorithm
Mosapride should not be used as first-line therapy for functional dyspepsia or GERD 5, 6
For functional dyspepsia: First complete H. pylori testing/eradication, then trial PPIs for 4-8 weeks, and only consider mosapride after these steps fail 5, 6
For GERD: Use mosapride only as adjunct therapy to standard-dose PPIs (e.g., lansoprazole 30 mg daily), particularly in patients with severe symptoms (symptom scores >18 points) 2
Mosapride is most effective for postprandial distress syndrome (PDS) symptoms within the functional dyspepsia spectrum 5
Special Population Adjustments
Elderly Patients
- No specific dose adjustment is documented in the available evidence for elderly patients 1, 2, 3, 7, 4
- The standard 5 mg TID regimen was used across age groups in clinical trials without age-specific modifications 1, 4
Renal Impairment
- No specific dosing guidance exists for patients with moderate renal impairment in the available literature 1, 2, 3, 7, 4
- Unlike other prokinetics that require renal dose adjustment, mosapride dosing recommendations do not address kidney function 8
Efficacy Considerations
Mosapride demonstrated mixed efficacy in controlled trials: effective in open-label studies but failed to show superiority over placebo in the largest randomized controlled trial 4
When combined with lansoprazole for GERD, mosapride provided additional benefit only in the subgroup with severe symptoms (pre-treatment scores >18), achieving greater symptom reduction than lansoprazole alone (mean difference 5.34 points, 95% CI 0.28-10.40) 2
Mosapride significantly reduced total acid exposure time and number of reflux episodes in 24-hour pH monitoring studies at 40 mg four times daily, though this higher dose is not standard practice 7
Safety Profile
Excellent tolerability with adverse events occurring in <5% of patients, including diarrhea/loose stools, dry mouth, malaise, and headache 1
No cardiac safety concerns reported, specifically no QT prolongation, distinguishing it from domperidone 3, 6
No significant adverse effects occurred in clinical trials using the standard 5 mg TID dosing 3
Critical Pitfalls to Avoid
Do not use mosapride as monotherapy for GERD or functional dyspepsia without first attempting acid suppression with PPIs 5, 6, 2
Do not escalate beyond 5 mg TID, as dose-finding studies showed no incremental benefit at 10 mg BID or 7.5 mg TID 4
Do not expect universal efficacy: the largest placebo-controlled trial showed no significant difference between mosapride and placebo in overall functional dyspepsia populations 4
Recognize that mosapride has weak recommendation with low-quality evidence according to major gastroenterology societies, contrasting with strong recommendations for PPIs and tricyclic antidepressants 5, 6