1. Introduction
Domperidone is a prokinetic and antiemetic agent used to manage nausea, vomiting, and certain gastrointestinal conditions. It works by blocking dopamine (D2) receptors in the chemoreceptor trigger zone (CTZ) and the gastrointestinal tract, enhancing gastric emptying and reducing symptoms of nausea and vomiting.
2. Indications
- Approved Indications:
- Relief of nausea and vomiting.
- Management of gastroparesis.
- Off-Label Uses:
- Gastroesophageal reflux disease (GERD) symptoms when standard therapy fails.
- Milk supply enhancement in breastfeeding (lactation induction) as a galactagogue.
3. Dosage
- Adults:
- 10 mg orally up to three times daily, 15–30 minutes before meals.
- Maximum duration of treatment: 1 week for nausea and vomiting.
- Children (>12 years and weight >35 kg):
- Same as adult dosage.
- Elderly:
- Use with caution; start at the lowest effective dose.
4. Administration
- Take orally 15–30 minutes before meals.
- Avoid using domperidone for prolonged periods unless under strict medical supervision.
5. Forms Available
- Tablets: 10 mg.
- Oral suspension: 1 mg/mL.
- Suppositories: Rarely available (specific regions).
6. Side Effects
6.1. Common Side Effects
- Dry mouth.
- Headache.
- Abdominal cramps.
6.2. Less Common Side Effects
- Diarrhoea.
- Rash or itching.
6.3. Rare but Serious Side Effects
- QT interval prolongation and cardiac arrhythmias.
- Extrapyramidal symptoms (uncommon, especially in adults).
- Galactorrhoea, gynaecomastia, or amenorrhoea due to increased prolactin levels.
7. Warnings
- Cardiovascular Risk: Increased risk of QT prolongation and serious ventricular arrhythmias, especially in patients over 60 years or those taking more than 30 mg/day.
- Use Duration: Should not exceed one week unless absolutely necessary under medical guidance.
8. Precautions
- Avoid in patients with known or suspected cardiac conditions (e.g., prolonged QT, arrhythmias, or significant bradycardia).
- Use cautiously in patients with electrolyte imbalances (e.g., hypokalaemia or hypomagnesaemia).
- Avoid combining with medications known to prolong the QT interval.
9. Interactions
- Drug-Drug Interactions:
- CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): Increased risk of QT prolongation and toxicity.
- Anticholinergic drugs: May counteract prokinetic effects.
- Dopamine agonists (e.g., levodopa): Reduced efficacy of domperidone.
- Drug-Food Interactions:
- Grapefruit juice may increase domperidone levels.
10. Monitoring Parameters
- Symptom relief (e.g., reduction in nausea or vomiting).
- Cardiac monitoring (ECG) in at-risk patients.
- Signs of extrapyramidal symptoms or hormonal imbalances (e.g., galactorrhoea).
11. Use in Children
- Approved for children over 12 years and weighing >35 kg.
- Not recommended in younger children or infants due to increased risk of side effects, including cardiac issues.
12. Use in Pregnancy
- Category C: Use only if the benefits outweigh the risks, as safety in pregnancy has not been established.
13. Use in Elderly
- Use with caution due to increased risk of cardiac side effects such as QT prolongation.
14. Use in Kidney Disease
- Dose adjustment may be required in patients with renal impairment.
- Monitor for side effects, as domperidone is primarily excreted via the kidneys.
15. Use in Liver Disease
- Contraindicated in moderate to severe hepatic impairment due to altered drug metabolism.
16. Patient Counselling Points
- Take domperidone 15–30 minutes before meals for optimal effectiveness.
- Inform your doctor immediately if you experience symptoms such as fainting, palpitations, or dizziness.
- Avoid grapefruit juice while taking domperidone.
- Do not exceed the prescribed dose or duration to minimise the risk of side effects.
- Inform your healthcare provider if you are taking other medications or have a history of cardiac conditions.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Motilium | Janssen | $15–25 (30 tablets, 10 mg) |
Generic Domperidone | Various | $10–15 (30 tablets, 10 mg) |
Motillium Oral Suspension | Janssen | $12–20 (100 mL, 1 mg/mL) |
18. FAQs (15 Questions)
- What is domperidone used for?
It is used to treat nausea, vomiting, and delayed gastric emptying. - How does domperidone work?
It blocks dopamine receptors in the gut and brain, reducing nausea and promoting gastric motility. - What are the common side effects of domperidone?
Common side effects include dry mouth, headache, and abdominal cramps. - Can domperidone cause heart problems?
Yes, it can increase the risk of QT prolongation and cardiac arrhythmias, particularly in high doses or in at-risk patients. - Is domperidone safe during pregnancy?
It should only be used if the benefits outweigh the risks, as safety in pregnancy is not well established. - Can domperidone be used for increasing breast milk production?
It is sometimes used off-label as a galactagogue, but only under medical supervision due to potential side effects. - How should domperidone be taken?
Take 15–30 minutes before meals, as directed by your healthcare provider. - What should I do if I miss a dose of domperidone?
Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double up. - Can domperidone interact with other medications?
Yes, it interacts with drugs such as CYP3A4 inhibitors, anticholinergics, and dopamine agonists. - Is domperidone safe for long-term use?
No, it is intended for short-term use (usually no longer than one week). - Can domperidone be taken with food?
It is most effective when taken before meals. - What are the signs of domperidone overdose?
Overdose symptoms include confusion, restlessness, and irregular heartbeats. Seek immediate medical attention. - Can children take domperidone?
It is approved for children over 12 years and >35 kg but is not recommended for younger children or infants. - How should domperidone be stored?
Store at room temperature, away from moisture and heat. - Can I drink alcohol while taking domperidone?
Alcohol is not recommended, as it may worsen side effects like drowsiness or dizziness.