Our hospital pharmacy has sent out information that the FDA has
strenthened its warning label about serious, even fatal, cardiac
arrythmias resulting from interactions between cisapride and several
other classes of drugs.

Cisapride (Propulsid) is a popular treatment for treflux in infants.
The medications with which interactions can occur, according to the
bulletin I read, include erythromycin and the following antifungals:
fluconazole (Diflucan), itraconazole (Sporanox), and ketakonozole
(Norvir).

I think the interaction between Propulsid and fluconazole could be of
particular relevance since a baby with reflux may be more likely to have
breastfeeding problems.  Doctors, pharmacists, what would happen if the
baby were on cisapride and the mother were treated for thrush with
fluconazole?  Sometimes doctors prescribe over the phone and sometimes
patients have prescriptions filled at different pharmacies.  Would a
pharmacist even think about the possibility that the mother has a
nursing baby?

Bonnie Jones, RN, ICCE, IBCLC
from the (not so sunny today) S.W. USA