Dosage Calculation for Domperidone, Clebopride, and Braxidin Combination
For the combination of domperidone, clebopride, and braxidin, domperidone should be dosed at 20 mg three to four times daily, while clebopride should be administered at standard antiemetic doses according to the specific formulation available. 1
Domperidone Dosing
- Standard adult dosing for domperidone is 20 mg orally 3-4 times daily for gastrointestinal motility disorders 1
- For pediatric patients, domperidone dosing is 0.2-0.3 mg/kg 3-4 times daily 1
- Maximum recommended daily dose should not exceed 80 mg due to risk of QT prolongation 2
- In patients with refractory gastroparesis, an average dose of 36 mg/day has shown clinical benefit 2
Clebopride Dosing
- Clebopride is typically administered at antiemetic doses similar to other dopamine antagonists 3
- As a prokinetic agent, clebopride's dosing should be adjusted based on patient response and tolerability 3
- Like other substituted benzamides, clebopride works through D2 receptor blockade in the gastrointestinal tract 3
Important Considerations for Combined Therapy
- Monitor for extrapyramidal side effects, which occur in approximately 1/10,000 patients taking domperidone, but may be more common with combined dopamine antagonists 4
- QT interval prolongation risk increases with higher doses of domperidone, requiring ECG monitoring in patients with cardiac risk factors 1
- Hyperprolactinemia is a potential side effect with all antidopaminergic prokinetics including both domperidone and clebopride 3
Special Populations
- For elderly patients or those with hepatic/renal impairment, consider starting with lower doses of both medications 1
- In pediatric patients, careful weight-based dosing of domperidone is required (0.2 mg/kg three times daily) 1
Monitoring and Follow-up
- Assess clinical response after 2-3 months of therapy 2
- Monitor for side effects including headache, palpitations, and diarrhea, which occur in approximately 38% of patients on domperidone 2
- Discontinuation rates due to adverse effects are approximately 12% for domperidone alone, but may be higher with combination therapy 2
Common Pitfalls to Avoid
- Avoid exceeding recommended doses, as higher doses increase risk of cardiac adverse events without necessarily improving efficacy 1
- Be aware that "braxidin" is not a recognized standard medication name in major pharmacopoeias - verify the actual compound before prescribing 1
- Do not combine multiple dopamine antagonists without careful monitoring, as this may increase risk of extrapyramidal symptoms 3, 4
- Fixed-dose combinations have predictable pharmacokinetics but limit flexibility in dosing; loose dosing allows for better individualization of therapy 5