Usage
Domperidone + Lafutidine is prescribed for various gastrointestinal disorders, primarily gastroesophageal reflux disease (GERD) and peptic ulcers. It also finds use in managing non-ulcer dyspepsia (indigestion), relieving symptoms such as nausea, vomiting, bloating, stomach pain, and early satiety (feeling full quickly). It can be used as an add-on therapy for Helicobacter pylori eradication.
It is classified as a gastroprokinetic (Domperidone) and H2-receptor antagonist (Lafutidine).
Domperidone works by blocking dopamine-2 receptors, thus increasing the movement and contractions of the stomach and intestines. It also reduces nausea and vomiting. Lafutidine, on the other hand, decreases stomach acid production by blocking histamine H2-receptors in the stomach lining. It also protects the gastric mucosa.
Alternate Names
While no direct alternate names exist for the combination, Domperidone + Lafutidine is marketed under brand names such as Lafudac D and Lafaxid-D. Domperidone is sometimes referred to as Motilium in some regions. Lafutidine is also known by the brand name Stogar among others.
How It Works
Pharmacodynamics: Domperidone is a dopamine D2-receptor antagonist that enhances gastric motility and emptying. Lafutidine competitively inhibits histamine at H2-receptors of the gastric parietal cells, reducing gastric acid secretion.
Pharmacokinetics:
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Domperidone: It has low oral bioavailability (about 15%) due to extensive first-pass metabolism. Food can slightly delay absorption. It is metabolized primarily in the liver and gut wall by CYP3A4 enzymes. Domperidone shows a 2- to 3-fold accumulation with repeated dosing.
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Lafutidine: It undergoes hepatic metabolism. The interaction between Lafutidine and Domperidone is not well documented. It is anticipated Lafutidine administration with Domperidone should not result in any significant pharmacokinetic interaction between the two drugs.
Mechanism of Action: Domperidone blocks peripheral dopamine D2-receptors. Lafutidine blocks histamine H2-receptors. Neither drug appears to directly influence CYP450 enzymes significantly. Elimination is primarily through hepatic metabolism for Lafutidine, while it’s mixed hepatic and renal for Domperidone.
Dosage
Standard Dosage
Adults:
The typical dose is one tablet or capsule of Domperidone 10mg + Lafutidine 30mg, taken 15-30 minutes before meals, up to three times a day. Some sources suggest 30-60 minutes before meals for the combination. Do not exceed 30mg of Domperidone and potentially up to 40mg daily in some instances when given alone. Do not exceed more than two 30mg suppositories of Domperidone in a 24 hour period.
Children:
Domperidone dosage in children is weight-based and should be carefully calculated. For children weighing less than 35kg, the dose is 0.25mg/kg, administered up to three times daily, with a maximum daily dose of 0.75 mg/kg. Due to the need for accurate dosing, tablets are generally unsuitable for use in children and adolescents weighing less than 35 kg, other formulations such as oral suspension are more suitable for this weight range.
Special Cases:
- Elderly Patients: Dose adjustments may be needed depending on renal and hepatic function.
- Patients with Renal Impairment: No specific dosage adjustment based on renal impairment is documented when Domperidone is used alone. Caution is advised in individuals with impaired renal function as a considerable portion of the medication and it’s metabolites are excreted renally.
- Patients with Hepatic Dysfunction: Domperidone is contraindicated in moderate to severe hepatic impairment. No dosage adjustment is needed in mild hepatic impairment.
- Patients with Comorbid Conditions: Caution is warranted in patients with cardiovascular disease, especially those at risk for QT prolongation.
Clinical Use Cases Clinical use cases of this combination outside of typical gastroenterological use is not explicitly documented.
Dosage Adjustments
Dose modifications may be required based on individual patient factors, including renal or hepatic impairment, other comorbidities, and concomitant medications.
Side Effects
Common Side Effects
Headache, dry mouth, diarrhea, dizziness, abdominal discomfort.
Rare but Serious Side Effects
Cardiac arrhythmias (QT prolongation), extrapyramidal reactions (especially in children).
Long-Term Effects
Hyperprolactinemia (elevated prolactin levels) with long-term Domperidone use.
Adverse Drug Reactions (ADR)
Allergic reactions, cardiac arrhythmias.
Contraindications
Hypersensitivity to domperidone or lafutidine; gastrointestinal hemorrhage, mechanical obstruction, or perforation; prolactinoma; moderate to severe hepatic impairment; concomitant use of potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole) or drugs that prolong the QT interval.
Drug Interactions
Antacids, anticholinergics, ketoconazole, itraconazole, erythromycin, and other drugs metabolized by CYP3A4.
Pregnancy and Breastfeeding
Domperidone is generally considered low risk during pregnancy (Australian Category A). It is excreted in breast milk, but adverse effects in infants are rare. Lafutidine data during pregnancy and breastfeeding are limited; use with caution if benefits outweigh risks.
Drug Profile Summary
- Mechanism of Action: Domperidone: Dopamine D2-receptor antagonist; Lafutidine: H2-receptor antagonist.
- Side Effects: Headache, dry mouth, diarrhea, dizziness, abdominal discomfort, rarely: cardiac arrhythmias, extrapyramidal reactions.
- Contraindications: Hypersensitivity, GI bleeding/obstruction/perforation, prolactinoma, hepatic impairment, QT-prolonging drugs.
- Drug Interactions: CYP3A4 inhibitors, QT prolonging drugs.
- Pregnancy & Breastfeeding: Domperidone: generally safe; Lafutidine: limited data, use with caution.
- Dosage: Adults: 10mg/30mg up to three times daily before meals; children: weight-based dosing.
- Monitoring Parameters: Cardiac rhythm (ECG if concerned about QT prolongation), liver function tests.
Popular Combinations
The combination of Domperidone and Lafutidine itself is a popular combination. Domperidone is also frequently combined with proton pump inhibitors for enhanced GERD symptom relief. Lafutidine is sometimes prescribed with antacids to address acute GERD symptoms. However, interactions should be considered.
Precautions
Screen for pre-existing medical conditions, including cardiac, hepatic, and renal dysfunction. Avoid alcohol and other CNS depressants while taking Domperidone.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Domperidone + Lafutidine?
A: The standard adult dosage is one tablet or capsule (Domperidone 10mg + Lafutidine 30mg) up to three times daily, taken 15-30 minutes before meals.
Q2: What are the primary uses of Domperidone + Lafutidine?
A: It is mainly used for GERD, peptic ulcers, and dyspepsia, providing relief from nausea, vomiting, and other gastrointestinal symptoms.
Q3: Are there any serious side effects I should be aware of?
A: Although rare, serious side effects can include cardiac arrhythmias (QT prolongation) and extrapyramidal symptoms (more common in children).
Q4: Can pregnant or breastfeeding women take this medication?
A: Domperidone is generally considered safe during pregnancy and breastfeeding. Lafutidine data is limited; discuss with a doctor to assess the benefit-risk ratio.
Q5: How does this combination drug work?
A: Domperidone improves gastric motility, while Lafutidine reduces stomach acid production. Together, they relieve gastrointestinal distress.
Q6: What should I avoid while taking Domperidone + Lafutidine?
A: Avoid alcohol, grapefruit juice, and QT-prolonging medications. Inform your physician of all medications you are taking.
Q7: What if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is close to the next scheduled dose. Do not double the dose.
Q8: Are there any specific dietary recommendations while on this medication?
A: While not mandatory, a diet low in spicy, acidic, and fatty foods may help in alleviating GERD and peptic ulcer symptoms.
Q9: How long should I take this medication?
A: The duration of treatment depends on the condition being treated and its severity. Always follow your doctor’s recommendations regarding the duration of treatment.
Q10: Can I take this medication with antacids?
A: Antacids can interact with Lafutidine and Domperidone. Consult your doctor before combining these medications.
