Domperidone

Generic name: Domperidone
Dosage form: oral tablet, oral suspension, oral drops, orally disintegrating tablet, suppository

Usage of Domperidone

Domperidone is an antiemetic (anti-sickness) and prokinetic drug. It belongs to a group of drugs called dopamine antagonists. It is used to treat stomach-related issues, such as nausea and vomiting, as well as stomach pain and discomfort caused by decreased movement of the stomach and upper gastrointestinal (GI) tract. It is also used to boost breastmilk supply.

Domperidone works by blocking dopamine receptors in the gut. It increases the movement or contractions of the muscles in your stomach and intestines, increasing how quickly and easily food moves through your digestive tract. It also acts on the chemoreceptor trigger zone in your brain, which is involved in nausea and vomiting. This area of your brain is outside the blood-brain barrier. Unlike other dopamine antagonists, domperidone does not cross the blood-brain barrier, which minimizes central nervous system (CNS) side effects.

Domperidone works to boost breastmilk supply by increasing the level of a hormone called prolactin, which stimulates the production of breastmilk.

Domperidone is available on prescription and in some places as an over-the-counter (OTC) medicine. It is available in many places around the world, including the UK, Europe, Canada and New Zealand. Approved uses of the drug vary from country to country. It is also used for off-label or unapproved conditions, including boosting breastmilk supply. Domperidone is not approved for use in the US, but some patients with severe gastrointestinal motility disorders can still access it through an expanded access investigation new drug (IND) application.

Domperidone first became available in the late 1970s.

Domperidone side effects

Domperidone can cause serious side effects. Stop taking domperidone and see your doctor or go to a hospital straightaway if:

You get swelling of the hands, feet, ankles, face, lips or throat which may cause difficulty in swallowing or breathing. You may also notice an itchy, lumpy rash (hives) or nettle rash (urticaria). This may mean you are having an allergic reaction to this medicine.

You notice any uncontrolled movements. These include irregular eye movements, unusual movements of the tongue, and abnormal posture such as a twisted neck, trembling and muscle stiffness. This is more likely to happen in children. These symptoms should stop once you stop taking this medicine.

You have a very fast or unusual heartbeat. This could be a sign of a life-threatening heart problem.

You have a fit (seizure).

Common side effects of domperidone include:

Dry mouth

Uncommon side effects of domperidone include:

Lowering of sexual drive (libido) in men

Feeling anxious

Feeling drowsy

Headaches

Diarrhea

Itchy skin. You may also have a rash

Unusual production of breast milk in men and women

Painful or tender breasts

A general feeling of weakness

Other side effects (frequency unknown) of domperidone include:

Disorders of the cardiovascular system: heart rhythm disorders (rapid or irregular heart beat) have been reported; if this happens, you should stop the treatment immediately. Domperidone may be associated with an increased risk of heart rhythm disorder and cardiac arrest. This risk may be more likely in those over 60 years old or taking doses higher than 30 mg per day.

Feeling agitated or irritable

Feeling more nervous than usual

Abnormal eye movements

Inability to urinate

Breast enlargement in men

In women, menstrual periods may be irregular or stop

A blood test shows changes in the way your liver is working

Some patients who have used this medicine for conditions and dosages requiring longer term medical supervision have experienced the following unwanted effects: Restlessness; swollen or enlarged breasts, unusual discharge from breasts, irregular menstrual periods in women, difficulty breastfeeding, depression, hypersensitivity.

Side effects such as feeling drowsy, nervous, agitated or irritable or having a fit are more likely to happen in children.

These are not all of the possible side effects of domperidone.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Before taking Domperidone

Tell your doctor if you are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed.

Domperidone is not usually recommended in pregnancy. There is limited information available about the use of this medicine in pregnant people. Domperidone should only be used during pregnancy when justified by the anticipated therapeutic benefit. Ask your doctor for advice before taking this medicine.

Domperidone is not usually recommended if you are breastfeeding. Small amounts of this medicine have been detected in breastmilk. It may cause unwanted side effects affecting the heart in a breastfed baby. Domperidone should be used during breastfeeding only if your doctor considers this clearly necessary. Ask your doctor for advice before taking this medicine.

How to use Domperidone

Adults and adolescents 12 years of age and older and with a body weight of 35 kg or more:

Tablet. The usual dose is one 10mg tablet taken up to three times per day, if possible before meals. It is usually recommended not to take more than three tablets (30 mg) per day, but in some cases your doctor may recommend taking up to 4 tablets (40 mg) per day.

Oral suspension. The usual dose is 10 ml taken up to three times per day, if possible before meals. Do not take more than 30 ml per day.

Suppositories. The usual dose is one 30 mg suppository two times a day. Do not use more than two suppositories per day.

See full prescribing information for more details about domperidone dosing.

Warnings

Domperidone may cause an increased risk of heart rhythm disorder and cardiac arrest. This risk may be more likely in those over 60 years old or taking doses higher than 30 mg per day. The risk also increases when it is given together with some drugs. Tell your doctor or pharmacist if you are taking drugs to treat infection (fungal infections or bacterial infection) and/or if you have heart problems or AIDS/HIV.

Domperidone should be used at the lowest effective dose in adults and adolescents 12 years of age and older and a body weight of 35kg or more.

While taking this medicine, contact your doctor if you experience heart rhythm disorders such as palpitations, trouble breathing, loss of consciousness. Treatment with domperidone should be stopped.

What other drugs will affect Domperidone

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Do not take domperidone if you are taking medicine to treat:

Fungal infections such as azole anti-fungals, specifically oral ketoconazole, fluconazole or voriconazole.

Bacterial infections, specifically erythromycin, clarithromycin, telithromycin, moxifloxacin, pentamidine (these are antibiotics)

Heart problems or high blood pressure (amiodarone, dronedarone, quinidine, disopyramide, dofetilide, sotalol, diltiazem, verapamil)

Psychoses (haloperidol, pimozide, sertindole)

Depression (citalopram, escitalopram)

Gastro-intestinal disorders (cisapride, dolasetron, prucalopride)

Allergy (mequitazine, mizolastine)

Malaria (in particular halofantrine)

AIDS/HIV (protease inhibitors)

Cancer (toremifene, vandetanib, vincamine)

Tell your doctor or pharmacist if you are taking drugs to treat infection, heart problems or AIDS/HIV.

Talk to your doctor if you need to take domperidone and apomorphine. Before you use these two medicines together your doctor will ensure that you can tolerate both when used simultaneously. Ask your doctor or specialist for advice.

It is important to ask your doctor or pharmacist if domperidone is safe for you when you are taking any other medicines, including medicines obtained without prescription.

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