Usage
Domperidone is primarily prescribed for the relief of nausea and vomiting, and to promote gastric motility (movement). It is also used to treat symptoms like bloating, upper abdominal discomfort, heartburn, and belching often associated with conditions like chronic gastritis and gastroparesis. In children, it is sometimes used for periodic vomiting associated with upper respiratory tract infections. It’s classified as a dopamine antagonist and prokinetic agent. Domperidone works by blocking dopamine receptors in the chemoreceptor trigger zone (CTZ) in the brain, which is responsible for triggering nausea and vomiting. It also increases the movement or contractions of the stomach and intestines, helping food move more quickly through the digestive system.
Alternate Names
While “Domperidone” is the generic name, it is marketed under various brand names globally, including Motilium, Peridon, and Domstal.
How It Works
Pharmacodynamics: Domperidone exerts its antiemetic effect by blocking dopamine D2 receptors in the CTZ. Its prokinetic action is due to its antagonistic effect on peripheral dopamine D2 receptors and, to a lesser extent, D3 receptors in the gastrointestinal tract. This leads to increased esophageal peristalsis, improved antroduodenal coordination, and accelerated gastric emptying. Domperidone does not readily cross the blood-brain barrier, which explains why extrapyramidal side effects are less common than with other dopamine antagonists.
Pharmacokinetics:
- Absorption: Domperidone is rapidly absorbed when taken orally, but bioavailability is relatively low (around 15%) due to extensive first-pass metabolism in the gut wall and liver. Taking it before meals enhances absorption.
- Metabolism: Primarily metabolized in the liver by CYP3A4 enzymes.
- Elimination: Primarily eliminated through hepatic metabolism, with a small portion excreted unchanged in urine and feces. The elimination half-life is approximately 7-9 hours in healthy individuals, but may be prolonged in patients with severe renal impairment.
Dosage
Standard Dosage
Adults:
The standard dose is 10 mg taken orally three times a day, preferably 15-30 minutes before meals. The maximum daily dose is usually 30 mg, but some patients may require up to 40 mg per day. Treatment duration should be as short as possible, typically not exceeding one week for adults.
Children (12 years and older, weighing 35 kg or more):
The same adult dosing applies.
Children (under 12 years or weighing less than 35 kg):
Oral domperidone is generally recommended at a dose of 0.25-0.5 mg/kg, up to three times daily. The maximum daily dose should not exceed 0.75mg/kg. It’s important to ensure the dosage is calculated accurately based on the child’s weight. For infants and young children, an oral suspension is typically used.
Special Cases:
- Elderly Patients: Start with a lower dose and increase cautiously as needed.
- Patients with Renal Impairment: Dosage frequency should be reduced to once or twice daily, depending on the severity of impairment. Dosage reduction may also be necessary.
- Patients with Hepatic Dysfunction: Domperidone is contraindicated in moderate to severe hepatic impairment. Dose adjustment may be required in mild hepatic impairment.
- Patients with Comorbid Conditions: Caution is advised in patients with cardiovascular disease, especially those at risk for QT prolongation.
Clinical Use Cases
Domperidone is typically not indicated for use in situations like intubation, surgical procedures, mechanical ventilation, ICU care, or emergency situations. Its primary use is in managing nausea and vomiting and gastrointestinal motility disorders.
Dosage Adjustments
Dose adjustments are crucial in patients with renal or hepatic impairment. Always consider drug interactions that may affect domperidone metabolism, such as CYP3A4 inhibitors.
Side Effects
Common Side Effects:
Dry mouth, headache, diarrhea, abdominal cramps, drowsiness, and galactorrhea (abnormal breast milk production).
Rare but Serious Side Effects:
Cardiac arrhythmias, including QT prolongation, torsades de pointes, and ventricular fibrillation. Extrapyramidal reactions (though rare, especially in adults, due to limited blood-brain barrier penetration) can occur, mainly in children and young adults.
Long-Term Effects:
Long-term use can lead to hormonal imbalances, particularly increased prolactin levels.
Adverse Drug Reactions (ADR):
Any sign of cardiac arrhythmia requires immediate discontinuation of the drug and medical intervention.
Contraindications
- Hypersensitivity to domperidone
- Gastrointestinal hemorrhage, mechanical obstruction or perforation
- Prolactinoma (a pituitary tumor)
- Concomitant use of QT-prolonging drugs or potent CYP3A4 inhibitors
- Moderate or severe hepatic impairment
Drug Interactions
Domperidone interacts with several drugs, including:
- QT prolonging agents (e.g., macrolide antibiotics, azole antifungals, some antipsychotics)
- CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin)
- Anticholinergic drugs (may reduce domperidone’s effectiveness)
Pregnancy and Breastfeeding
Domperidone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Its safety during breastfeeding has not been fully established; however, small amounts are excreted in breast milk, potentially causing adverse effects in infants. Discuss potential risks and benefits with patients who are pregnant or breastfeeding.
Drug Profile Summary
- Mechanism of Action: Dopamine D2 receptor antagonist in the CTZ and peripherally in the GI tract.
- Side Effects: Dry mouth, headache, diarrhea, extrapyramidal reactions (rare), QT prolongation (rare but serious).
- Contraindications: Hypersensitivity, GI bleeding/obstruction/perforation, prolactinoma, concurrent use of QT prolonging drugs, moderate/severe hepatic impairment.
- Drug Interactions: QT-prolonging drugs, CYP3A4 inhibitors, anticholinergics.
- Pregnancy & Breastfeeding: Use with caution; assess risk/benefit ratio.
- Dosage: Adults: 10mg TID (max 30-40mg/day). Children: 0.25-0.5mg/kg TID (max 0.75mg/kg/day).
- Monitoring Parameters: ECG (if cardiac concerns), electrolyte levels.
Popular Combinations
Domperidone is sometimes used in combination with paracetamol or ibuprofen for the management of nausea and vomiting, but always carefully assess potential drug interactions and cumulative side effects.
Precautions
Screen for any contraindications before starting treatment. Exercise caution in elderly patients and those with renal impairment. Monitor for any signs of cardiac events, including QT prolongation. Advise patients about potential side effects and drug interactions. Restrict alcohol and driving if drowsiness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Domperidone?
A: Adults: 10mg three times a day (max 30-40mg/day). Children (12+ years and ≥35kg): Same as adult dose. Children (under 12 or <35kg): 0.25-0.5 mg/kg three times a day (max 0.75 mg/kg/day).
Q2: What are the most common side effects?
A: Dry mouth, headache, diarrhea, and abdominal cramps.
Q3: Is Domperidone safe in pregnancy?
A: Use with caution during pregnancy only if the benefits outweigh the risks. Consult a specialist.
Q4: Can Domperidone be used during breastfeeding?
A: Limited data available; small amounts are excreted in breast milk. Consult a specialist.
Q5: What are the serious side effects to watch out for?
A: Cardiac arrhythmias, including QT interval prolongation. Seek immediate medical attention if any signs occur.
Q6: What are the contraindications for Domperidone use?
A: Gastrointestinal bleeding, obstruction, perforation; Prolactinoma; Concomitant use of QT-prolonging drugs; Moderate or severe hepatic impairment.
Q7: Does Domperidone interact with other medications?
A: Yes, it can interact with QT-prolonging drugs, CYP3A4 inhibitors (like ketoconazole and erythromycin), and anticholinergic medications.
Q8: How does Domperidone work at the cellular level?
A: It acts as a dopamine D2 receptor antagonist at the cellular level, blocking dopamine’s effects, both centrally in the CTZ and peripherally in the gastrointestinal tract.
Q9: What should patients be advised regarding lifestyle while on Domperidone?
A: Patients should limit alcohol intake and avoid activities requiring alertness, like driving, if drowsiness occurs.
This information is current as of February 16, 2025, and is intended for healthcare professionals in India. Always consult the latest prescribing information and clinical guidelines.
