Usage
Domperidone + Esomeprazole is prescribed for the treatment of gastroesophageal reflux disease (GERD) that does not respond adequately to esomeprazole alone. It is specifically indicated for the relief of GERD symptoms such as heartburn, acid regurgitation, and dyspepsia in adults.
It combines a proton pump inhibitor (PPI) with a prokinetic agent.
Pharmacological Classification:
- Esomeprazole: Proton Pump Inhibitor (Antisecretory)
- Domperidone: Dopamine antagonist (Prokinetic)
Mechanism of Action:
Esomeprazole reduces gastric acid secretion by irreversibly inhibiting the H+/K+-ATPase enzyme system at the secretory surface of the gastric parietal cell. Domperidone is a dopamine antagonist that blocks the inhibitory effects of dopamine on gastrointestinal motility and increases lower esophageal sphincter tone. It also exerts antiemetic effects.
Alternate Names
There is no officially recognized alternate name for this combination product. However, each component has its own alternate names:
- Esomeprazole: (S)-omeprazole, Nexium (brand name)
- Domperidone: Motilium (brand name)
Various brand names exist depending on the manufacturer.
How It Works
Pharmacodynamics: Esomeprazole suppresses gastric acid secretion, while domperidone enhances gastric emptying and improves esophageal motility.
Pharmacokinetics:
- Esomeprazole: Absorbed in the small intestine, metabolized in the liver by CYP2C19 and CYP3A4, and excreted primarily in the urine.
- Domperidone: Absorbed in the small intestine, metabolized in the liver and gut wall, and excreted in the urine and feces.
Mode of Action:
- Esomeprazole: Irreversibly inhibits H+/K+-ATPase in gastric parietal cells, reducing acid secretion.
- Domperidone: Antagonizes dopamine D2 receptors in the chemoreceptor trigger zone and the gastrointestinal tract, leading to prokinetic and antiemetic effects.
Elimination Pathways:
- Esomeprazole: Primarily renal excretion.
- Domperidone: Renal and hepatic excretion.
Dosage
Standard Dosage
Adults:
One capsule containing 40mg esomeprazole and 30mg domperidone once daily, preferably in the morning, taken at least one hour before a meal, for 4 to 8 weeks.
Children:
This combination is not recommended for children below 12 years of age. Individual components might have pediatric doses. Consult specific recommendations for esomeprazole and domperidone pediatric dosing.
Special Cases:
- Elderly Patients: No specific dose adjustments are typically needed, but cautious use is recommended due to potential age-related decline in organ function.
- Patients with Renal Impairment: No dose adjustments are necessary for esomeprazole. For domperidone, dose reduction might be needed depending upon the severity of renal impairment.
- Patients with Hepatic Dysfunction: S-RD Capsules can be used in mild hepatic impairment, but are contraindicated in moderate to severe hepatic impairment.
- Patients with Comorbid Conditions: Use with caution in patients with cardiac diseases, electrolyte imbalances, or those taking QT-prolonging drugs.
Clinical Use Cases
The combination of domperidone and esomeprazole is not typically used in the specific clinical settings of intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations.
Dosage Adjustments
Dose adjustments might be necessary based on individual patient response and tolerance. Consult a gastroenterologist or physician for individualized recommendations.
Side Effects
Common Side Effects
Headache, diarrhea, abdominal pain, nausea, dry mouth, flatulence.
Rare but Serious Side Effects
Cardiac arrhythmias (QT prolongation), extrapyramidal symptoms (e.g., tremors, dystonia), hyperprolactinemia (galactorrhea, gynecomastia).
Long-Term Effects
Osteoporosis with prolonged use of PPIs, potential for increased risk of Clostridium difficile infection. Long-term data on the combined use are limited.
Adverse Drug Reactions (ADR)
Angioedema, anaphylaxis, Stevens-Johnson syndrome (rarely).
Contraindications
Hypersensitivity to esomeprazole, domperidone, or substituted benzimidazoles; gastrointestinal hemorrhage, mechanical obstruction, or perforation; prolactinoma; moderate to severe hepatic impairment; concurrent use with QT prolonging drugs, rilpivirine, or potent CYP3A4 inhibitors; significant electrolyte disturbances; underlying cardiac disease such as congestive heart failure (CHF).
Drug Interactions
Esomeprazole can interact with drugs metabolized by CYP2C19 and CYP3A4. Domperidone can interact with drugs that prolong the QT interval, anticholinergics, and ketoconazole. Avoid concurrent use with potent CYP3A4 inhibitors.
Pregnancy and Breastfeeding
Limited data are available. Use only if clearly needed and the potential benefits outweigh the risks. Domperidone is excreted in breast milk; use with caution while breastfeeding.
Drug Profile Summary
- Mechanism of Action: Esomeprazole reduces gastric acid, domperidone improves gastric motility.
- Side Effects: Headache, diarrhea, QT prolongation (rare).
- Contraindications: Hypersensitivity, GI bleeding/obstruction, prolactinoma, severe liver disease.
- Drug Interactions: CYP3A4 inhibitors, QT prolonging drugs.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: One capsule (40mg/30mg) daily.
- Monitoring Parameters: Symptoms of GERD, ECG in patients with cardiac risk factors.
Popular Combinations
Not applicable. This is a combination product. However, individual components can have specific combinations.
Precautions
Assess for allergies, renal/hepatic function, cardiac conditions, and electrolyte imbalances before starting treatment. Avoid use in pregnancy and breastfeeding unless clearly needed. Exercise caution when driving or operating machinery as it can cause dizziness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Domperidone + Esomeprazole?
A: One capsule (40mg esomeprazole / 30mg domperidone) once daily, taken at least one hour before a meal.
Q2: Can this combination be used in pregnancy?
A: Use with caution during pregnancy only if the benefits outweigh the potential risks. Consult an obstetrician for detailed assessment.
Q3: What are the common side effects?
A: Headache, diarrhea, abdominal pain, nausea, dry mouth.
Q4: What are the contraindications for Domperidone + Esomeprazole?
A: Gastrointestinal bleeding, mechanical obstruction or perforation; prolactinoma; moderate to severe hepatic dysfunction; QT interval prolonging drugs; hypersensitivity to components.
Q5: Are there any drug interactions to be aware of?
A: Yes, interactions with CYP3A4 inhibitors and QT prolonging drugs. Always check for potential interactions with other medications the patient might be taking.
Q6: How does Domperidone + Esomeprazole work?
A: Esomeprazole reduces gastric acid secretion, while domperidone promotes gastric emptying and improves esophageal motility.
Q7: Can this combination be used in children?
A: This combination is not recommended for use in children below 12 years of age. Consult pediatric guidelines for individual drug components.
Q8: What should I monitor in patients taking this medication?
A: Monitor for GERD symptom improvement, and consider ECG monitoring in patients with cardiac risk factors.
Q9: Can this medication be crushed or chewed?
A: No. The capsules should be swallowed whole with water and must not be opened, chewed, or crushed.
