What is the recommended use and dosage of Domperidone (generic name) for treating nausea and vomiting?

Domperidone for Nausea and Vomiting Treatment

Domperidone is recommended at a dose of 10-20 mg three times daily for treating nausea and vomiting, with a starting dose of 10 mg three times daily preferred for safety considerations related to QT prolongation risk. 1

Mechanism and Clinical Applications

• Domperidone is a dopamine D2-receptor antagonist that does not readily cross the blood-brain barrier, resulting in fewer central nervous system side effects compared to other antiemetics like metoclopramide 1
• It functions as both a prokinetic agent (stimulating gastric emptying) and an antiemetic, making it particularly useful for conditions with upper gastrointestinal motility disorders 2
• Domperidone is effective for treating nausea and vomiting associated with:
  • Chemotherapy-induced nausea and vomiting 1
  • Gastroparesis (both diabetic and idiopathic) 1, 2
  • Functional dyspepsia and early satiety 1, 3

Dosing Recommendations

• For adults with nausea and vomiting:
  • Starting dose: 10 mg three times daily 1
  • Maximum dose: 20 mg three to four times daily 1
  • Duration: Short-term use is preferred due to safety considerations 4
• Symptom improvement can be observed as early as day 3 of treatment 2
• In chemotherapy settings, domperidone 20 mg is typically administered 3-4 times daily 1

Efficacy Evidence

• Domperidone significantly improves overall gastroparesis symptoms, particularly:
  • Early satiety and postprandial fullness (p<0.05) 2
  • Nausea (borderline improvement, p=0.055) 2
• In patients with chronic unexplained upper gastrointestinal symptoms, domperidone (20 mg four times daily) significantly improved symptom scores compared to placebo (p<0.05) 3
• For refractory nausea and vomiting, particularly in chemotherapy settings, adding dopamine antagonists like domperidone to serotonin antagonists and corticosteroids is recommended 1

Safety Considerations and Monitoring

• Cardiovascular safety:

  • QT prolongation and torsade de pointes tachycardia are potential risks, particularly with intravenous administration 1
  • Risk appears low with usual therapeutic oral doses 1
  • Avoid doses above 10 mg three times daily when possible to minimize cardiac risks 1
  • ECG monitoring may be warranted, especially in patients with other risk factors for QT prolongation 1

• Common side effects include:

  • Palpitations, headache, breast tenderness, menstrual changes, dizziness, drowsiness 2
  • Gastrointestinal effects (constipation) 2

• Availability considerations:

  • In the United States, domperidone is only available through an FDA investigational drug application 1
  • It is more readily available in other countries 4

Special Populations

• Pediatric use:

  • Currently restricted to relief of nausea and vomiting in children older than 12 years for short periods 4
  • Off-label use occurs for gastroesophageal reflux disease, dyspepsia, and gastroparesis in pediatric populations, though evidence is limited 4

• Cancer patients:

  • Particularly useful for chemotherapy-induced nausea and vomiting 1
  • Can be added to standard antiemetic regimens for refractory cases 1

Alternative Options

• If domperidone is unavailable or contraindicated, alternatives include:
  • Metoclopramide (5-20 mg three to four times daily), though it has more central nervous system side effects 1
  • 5-HT3 receptor antagonists like ondansetron (4-8 mg twice or three times daily) 1
  • Phenothiazine antipsychotics such as prochlorperazine (5-10 mg four times daily) 1

Domperidone offers an effective treatment option for nausea and vomiting with fewer central nervous system side effects than metoclopramide, though cardiac monitoring is warranted due to potential QT prolongation risks 1.