Domperidone

What it is and how it works

Domperidone blocks dopamine D2 receptors in the chemoreceptor trigger zone, which lies outside the blood–brain barrier, and in the upper gastrointestinal tract, increasing gastric motility and producing an antiemetic effect. It penetrates the brain poorly, so extrapyramidal effects are uncommon.

Indications

Relief of the symptoms of nausea and vomiting in adults and adolescents (and, with specific weight-based dosing, in children where authorised).

Dosage and administration (summary)

Adults and adolescents 35 kg or more: 10 mg orally up to three times daily, maximum 30 mg daily; treatment duration should not usually exceed 1 week.

Contraindications

Moderate or severe hepatic impairment; prolongation of cardiac conduction intervals (particularly QT), significant electrolyte disturbances or underlying cardiac disease such as heart failure; co-administration with QT-prolonging drugs or potent CYP3A4 inhibitors; prolactinoma; and situations where gastric stimulation is harmful (haemorrhage, obstruction, perforation).

Warnings and precautions

Associated with QT prolongation, serious ventricular arrhythmias and sudden cardiac death, particularly in patients over 60 years, at daily doses above 30 mg and with interacting drugs; use the lowest effective dose for the shortest time. Hyperprolactinaemia-related effects such as galactorrhoea and gynaecomastia may occur. Reduce dosing frequency in severe renal impairment.

Pregnancy

Use in pregnancy only if justified by the expected benefit; data are limited.

Storage and supply

Store below 30 °C.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.