Domperidone 💊
📖 About
Always check the BNF link here.
- 💊 Domperidone is an anti-emetic and pro-kinetic agent.
- ✅ Particularly useful in Parkinson’s disease as it does not cross the blood–brain barrier as readily as metoclopramide (lower risk of worsening motor symptoms).
- ⚠️ Associated with cardiac arrhythmia risk → use restricted to lowest effective dose, shortest duration.
⚡ Mechanism of Action
- ⛔ Peripheral dopamine D₂ receptor antagonist.
- Acts at the chemoreceptor trigger zone (CTZ), which lies outside the blood–brain barrier.
- ⬆️ Enhances gastric emptying and motility (mild pro-kinetic effect).
💊 Dosing – Domperidone (verify with BNF/datasheet)
| Drug |
Details |
| 💊 Domperidone |
• Starting dose: 10–20 mg
• Frequency: Up to TDS
• Route: PO / PR
|
- 📌 Use the lowest effective dose, for the shortest possible duration (usually ≤7 days).
- 💧 Dose reduction required in renal impairment.
🩺 Indications
- 🤢 Nausea and vomiting of various causes.
- 🎗️ Nausea/vomiting related to chemotherapy (specialist use).
- 🧠 Nausea/vomiting in Parkinson’s disease (advantage over metoclopramide due to reduced central D₂ blockade).
🔄 Interactions
- See BNF – ↑ risk of arrhythmias when combined with QT-prolonging drugs (e.g. macrolides, fluoroquinolones, some antipsychotics).
- Metabolised via CYP3A4 – inhibitors (e.g. ketoconazole, ritonavir) ↑ plasma domperidone levels.
⚠️ Cautions
- 💔 Risk of QT prolongation and serious ventricular arrhythmias (especially in elderly >60 years or with cardiac disease).
- ⚠️ Use only when benefits outweigh risks; avoid high doses and prolonged courses.
- 💧 Adjust dose in renal impairment.
🚫 Contraindications
- Known prolonged QT interval or significant cardiac disease (e.g. heart failure).
- Concomitant use with QT-prolonging medicines or strong CYP3A4 inhibitors.
- Severe hepatic impairment.
- Hypersensitivity to domperidone.
💥 Side Effects
- 🧠 Rare extrapyramidal symptoms (much less common than with metoclopramide).
- 🧬 Hyperprolactinaemia → galactorrhoea, gynaecomastia, amenorrhoea.
- 💔 QT prolongation, ventricular arrhythmias, sudden cardiac death (dose-related, main reason for restricted use).
- 🤢 GI upset: abdominal cramps, dry mouth, diarrhoea.
📑 References
