From the Research
Domperidone dosing for pediatric patients is typically weight-based, with the recommended oral dose being 0.2-0.4 mg/kg given 3-4 times daily, up to a maximum of 2.4 mg/kg/day, as supported by the most recent study 1.
Key Considerations
- For infants and children weighing less than 35 kg, the usual starting dose is 0.25 mg/kg, while children weighing more than 35 kg or adolescents may receive 10-20 mg per dose.
- Treatment duration should generally be limited to the shortest time necessary to control symptoms, typically not exceeding one week for acute nausea and vomiting.
- Domperidone works by blocking dopamine receptors in the chemoreceptor trigger zone and enhancing gastric motility, making it effective for treating nausea, vomiting, and gastroesophageal reflux.
Safety Precautions
- Caution is warranted due to potential cardiac side effects, including QT prolongation, which is why lower doses are preferred, especially in patients with cardiac conditions or those taking other medications that may affect cardiac conduction, as highlighted in 1.
- Domperidone should be avoided in patients with moderate to severe hepatic impairment, and dose adjustments may be necessary for those with renal dysfunction.
Evidence Summary
- A systematic review and meta-analysis 1 evaluated the profile of adverse events associated with domperidone and metoclopramide in gastroparesis, confirming concerns of cardiovascular, extrapyramidal, and endocrine adverse events.
- Another study 2 found that low-dose domperidone did not significantly differ from placebo in reducing vomiting and nausea episodes in pediatric patients with acute gastroenteritis, with a similar safety profile between both groups.
- Prescribing patterns and safety signals of domperidone in pediatric patients have been evaluated in several studies, including 3 and 4, highlighting the need for careful consideration of adverse cardiac effects and the importance of evidence-based prescribing.