Usage
Domperidone + Ilaprazole is prescribed for the management of gastroesophageal reflux disease (GERD), peptic ulcers, dyspepsia, and gastroparesis. It is also used to treat nausea and vomiting. This combination medication falls under the pharmacological classifications of gastrointestinal agents, specifically proton pump inhibitors (PPIs) and antiemetics.
Domperidone increases the movements or contractions of the stomach and intestines, speeding up the transit of food through the digestive system. Ilaprazole decreases the amount of acid produced in the stomach.
Alternate Names
There are no widely recognized alternate names for this specific combination drug, although it may sometimes be referred to as Ilaprazole/Domperidone. Brand names may vary regionally.
How It Works
Pharmacodynamics: Domperidone is a dopamine antagonist that blocks dopamine receptors in the chemoreceptor trigger zone (CTZ) and the vomiting center, reducing nausea and vomiting. It also acts peripherally to increase esophageal peristalsis and accelerate gastric emptying. Ilaprazole is a proton pump inhibitor. It irreversibly binds to the hydrogen-potassium ATPase enzyme (proton pump) in gastric parietal cells, inhibiting gastric acid secretion.
Pharmacokinetics: Domperidone is rapidly absorbed orally, reaching peak plasma concentrations within 30-60 minutes. It undergoes hepatic metabolism, primarily via CYP3A4. Ilaprazole is also rapidly absorbed and extensively metabolized in the liver by CYP enzymes, primarily CYP3A4 and CYP2C19. Both drugs are primarily eliminated through hepatic routes, with some renal excretion.
Dosage
Dosage guidelines should be individualized based on the patient’s condition and response. Always consult with a healthcare professional to determine the appropriate dose.
Standard Dosage
Adults:
A common adult dosage is one tablet containing 10mg Ilaprazole and 30mg Domperidone, taken once daily, 15-30 minutes before a meal. However, the specific formulation and dosage may vary depending on the indication and the prescribing physician’s judgment.
Children:
The safety and effectiveness of Domperidone + Ilaprazole have not been established in children under 12 years old. Some sources indicate its use in children over 12 years old, but specific dosing recommendations vary. Consult a pediatrician for appropriate guidance.
Special Cases:
- Elderly Patients: Dosage adjustments may be required based on renal and hepatic function.
- Patients with Renal Impairment: Dose reduction may be necessary.
- Patients with Hepatic Dysfunction: Domperidone + Ilaprazole should be used with caution, and dosage adjustments are typically required. In moderate to severe hepatic impairment, it may be contraindicated.
- Patients with Comorbid Conditions: Adjustments may be necessary based on the specific condition.
Clinical Use Cases
The fixed-dose combination of Domperidone + Ilaprazole is not typically used in the context of intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. In these cases, separate formulations and individualized dosing of each drug are preferred to provide greater control over treatment.
Dosage Adjustments
Dosage adjustments are based on patient-specific factors such as age, renal function, hepatic function, and comorbidities. Genetic polymorphisms affecting drug metabolism, particularly CYP2C19, may also influence drug efficacy and require dose modifications.
Side Effects
Common Side Effects:
- Diarrhea
- Stomach pain
- Flatulence
- Dry mouth
- Headache
- Dizziness
- Fatigue
Rare but Serious Side Effects:
- Cardiac arrhythmias (QT prolongation)
- Extrapyramidal symptoms (e.g., tremors, dystonia)
- Hyperprolactinemia
Long-Term Effects:
- Increased risk of fractures with long-term PPI use
- Potential for vitamin B12 deficiency
- Increased risk of Clostridium difficile infection
Contraindications
- Hypersensitivity to domperidone, ilaprazole, or any component of the formulation
- Gastrointestinal bleeding
- Mechanical obstruction of the gastrointestinal tract
- Perforation of the gastrointestinal tract
- Prolactinoma
- Moderate to severe hepatic impairment
- Concomitant use of drugs that prolong the QT interval (e.g., certain antiarrhythmics, antipsychotics)
- Concomitant use of potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole)
Drug Interactions
- Ketoconazole, itraconazole (CYP3A4 inhibitors) can increase plasma concentrations of both domperidone and ilaprazole.
- Drugs that prolong the QT interval (e.g., amiodarone, sotalol, certain antipsychotics) may increase the risk of cardiac arrhythmias.
- Antacids may decrease the absorption of ilaprazole.
- Ilaprazole may decrease the absorption of certain drugs that require an acidic environment (e.g., ketoconazole, iron salts).
Pregnancy and Breastfeeding
Domperidone + Ilaprazole should be used with caution during pregnancy and breastfeeding. Consult a healthcare professional to assess the benefit-risk ratio. Limited data are available on the use of this combination during pregnancy. Domperidone is excreted in breast milk, and while amounts are small, its use during breastfeeding should be evaluated carefully.
Drug Profile Summary
- Mechanism of Action: Domperidone is a dopamine antagonist that increases gastrointestinal motility and reduces nausea and vomiting. Ilaprazole is a proton pump inhibitor that reduces gastric acid secretion.
- Side Effects: Diarrhea, stomach pain, flatulence, dry mouth, headache, dizziness, and QT prolongation.
- Contraindications: Hypersensitivity, GI bleeding or obstruction, prolactinoma, hepatic impairment, concomitant use of QT-prolonging drugs or potent CYP3A4 inhibitors.
- Drug Interactions: CYP3A4 inhibitors, QT prolonging drugs, antacids.
- Pregnancy & Breastfeeding: Use with caution. Consult a healthcare professional.
- Dosage: Varies depending on indication and patient factors. Typically one tablet containing 10mg ilaprazole and 30mg domperidone, taken once daily before meals.
- Monitoring Parameters: Electrolytes, liver function tests, ECG for QT interval, symptoms of adverse effects.
Popular Combinations
While Domperidone + Ilaprazole is itself a combination, other drugs, like antacids for symptom relief may be added to the therapeutic regimen. However, the need for such combinations should be assessed on a case-by-case basis.
Precautions
- Patients with renal or hepatic impairment should be closely monitored.
- Baseline ECG should be considered, especially in patients at risk of QT prolongation.
- Monitor for extrapyramidal symptoms, particularly in elderly patients.
- Monitor for signs and symptoms of hyperprolactinemia (e.g., galactorrhea, amenorrhea, gynecomastia).
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Domperidone + Ilaprazole?
A: The usual adult dosage is one tablet containing 10mg Ilaprazole and 30mg Domperidone once daily, taken before meals. Pediatric and geriatric dosing may vary. Dosage adjustments are required for patients with renal or hepatic impairment.
Q2: How does this combination work in GERD?
A: Domperidone enhances gastric emptying and reduces esophageal reflux, while Ilaprazole suppresses gastric acid production, providing relief from GERD symptoms.
Q3: What are the common side effects?
A: Common side effects include diarrhea, stomach pain, flatulence, dry mouth, headache, dizziness, and fatigue.
Q4: Are there any serious drug interactions I should be aware of?
A: Yes. Concomitant use of drugs that prolong the QT interval (e.g., certain antiarrhythmics, antipsychotics) or potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole) can lead to serious adverse events.
Q5: Can this drug be used during pregnancy?
A: Domperidone + Ilaprazole should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult a healthcare professional.
Q6: Is it safe to take this medication while breastfeeding?
A: Domperidone is excreted in breast milk. The decision to use this medication while breastfeeding should be made in consultation with a healthcare professional.
Q7: How should I manage a patient who overdoses on this medication?
A: Overdose may manifest as drowsiness, confusion, and uncontrolled muscle movements. Treatment is supportive and may involve gastric lavage, activated charcoal, and monitoring vital signs. Severe cases may require hospitalization.
Q8: Can patients with renal impairment take this medicine?
A: Patients with renal impairment may require dosage adjustments. Consult a healthcare professional.
Q9: What should I do if a patient misses a dose?
A: If a dose is missed, advise the patient to take the missed dose as soon as possible unless it is close to the next scheduled dose. Do not double the dose.
Q10: How long should a patient take Domperidone + Ilaprazole?
A: The duration of treatment depends on the individual patient’s condition and response to therapy. It should be determined by the prescribing physician.
