From the Guidelines
Domperidone is a dopamine D2-receptor antagonist that is used to treat nausea, vomiting, and certain gastrointestinal disorders, with a recommended starting dose of 10 mg 3 times a day, although its use is limited by cardiovascular safety considerations, particularly QT prolongation and ventricular tachycardia, as reported in a study published in Clinical Gastroenterology and Hepatology 1.
Key Points
- Domperidone does not readily cross the blood-brain barrier, resulting in fewer central side effects compared to metoclopramide, as noted in the study 1.
- The medication has modest efficacy in improving symptom scores in patients with gastroparesis, with 68% of patients showing improvement in a single-center cohort study, although 7% experienced cardiac side effects requiring drug cessation 1.
- Due to cardiovascular safety concerns, the dose should probably not be escalated to 20 mg 4 times a day, and patients with existing heart conditions or those taking other medications that affect heart rhythm should use domperidone with caution under medical supervision.
Important Considerations
- Domperidone is not FDA-approved in the United States and is only available through an FDA investigational drug application, as mentioned in the study 1.
- Patients should be monitored for cardiac side effects, and the medication should be used with caution in patients with a history of heart conditions or those taking other medications that may affect heart rhythm.
- The use of domperidone should be weighed against the potential benefits and risks, particularly in patients with refractory gastroparesis, and alternative treatment options should be considered, such as 5-HT3 receptor antagonists or neurokinin receptor antagonists, as discussed in the study 1.
From the FDA Drug Label
Domperidone is a D2 dopamine receptor antagonist that blocks the agonistic action of fescue alkaloids at the cellular level. Domperidone is a D2 dopamine receptor antagonist. Domperidone is a motility agent that acts as a D2 dopamine receptor antagonist 2 2.
- It works by blocking the action of dopamine in the gastrointestinal tract, which helps to enhance motility.
- The exact mechanism of action is not fully described in the provided drug labels, but it is known to have effects on the gastrointestinal system.
From the Research
Definition and Mechanism of Action
- Domperidone is a dopamine receptor antagonist with peripheral prokinetic and central antiemetic properties 3, 4, 5.
- It acts as an antiemetic and a prokinetic agent through its effects on the chemoreceptor trigger zone and motor function of the stomach and small intestine 5.
Clinical Applications
- Domperidone is used to treat nausea and vomiting, gastroparesis, and as a galactogogue (to promote lactation) 3, 4, 5.
- It is also used to treat other conditions such as dumping syndrome, cyclic vomiting, and conditioned vomiting 3.
Safety Profile
- Domperidone has been associated with prolongation of the QTc interval, which can increase the risk of cardiac arrhythmias 3, 4, 6.
- The risk of cardiac toxicity is higher when domperidone is co-administered with QT-interacting medications 6.
- Domperidone should not be administered to subjects with pre-existing QT prolongation/LQTS, subjects receiving drugs that inhibit CYP3A4, subjects with electrolyte abnormalities or with other risk factors for QT-prolongation 4.