From the Research
Domperidone can cause hyponatremia, although it is not among its most common side effects. The mechanism by which domperidone may lead to hyponatremia involves its effect on prolactin secretion, which can potentially influence antidiuretic hormone (ADH) regulation, leading to inappropriate water retention and subsequent dilutional hyponatremia 1.
Key Points to Consider
- Domperidone is a dopamine receptor antagonist primarily used as an antiemetic and prokinetic agent.
- Patients at higher risk of developing hyponatremia while on domperidone include the elderly, those with renal impairment, and individuals taking other medications that affect sodium balance.
- Symptoms of hyponatremia can range from mild and nonspecific, such as weakness or nausea, to severe and life-threatening, such as seizures or coma 2.
- Management of domperidone-induced hyponatremia typically involves discontinuation or dose adjustment of domperidone, along with appropriate correction of sodium levels based on the severity and acuity of the hyponatremia.
Clinical Approach
- Healthcare providers should be aware of the potential for domperidone to cause hyponatremia and consider checking sodium levels in patients who develop symptoms suggestive of hyponatremia.
- The approach to managing hyponatremia should consist of treating the underlying cause, and for most patients, this means addressing the use of domperidone and its impact on ADH regulation 2.
- In cases of severely symptomatic hyponatremia, treatment with bolus hypertonic saline may be necessary to rapidly correct serum sodium levels, but this should be done with caution to avoid overly rapid correction, which can lead to osmotic demyelination 2.
Evidence Summary
The evidence provided does not directly link domperidone with hyponatremia in the included studies 3, 4, 5, but the mechanism of action of domperidone and its potential to influence ADH regulation, as discussed in the context of drug-induced hyponatremia 1, supports the possibility of domperidone causing hyponatremia. The most recent and highest quality study on hyponatremia management and diagnosis 2 guides the approach to managing suspected domperidone-induced hyponatremia.