Domperidone vs Domperidone SR: Key Differences
Standard domperidone (immediate-release) at 10-20 mg three times daily is the recommended formulation, as there is no evidence supporting the use of sustained-release (SR) formulations in clinical guidelines, and all efficacy data and dosing recommendations are based on immediate-release preparations.
Critical Evidence Gap
The provided evidence and current gastroenterology guidelines exclusively address immediate-release domperidone formulations. No guideline-level evidence exists for domperidone SR formulations in terms of dosing, efficacy, or safety profiles 1.
Standard Domperidone Dosing (Immediate-Release)
Recommended dosing regimen:
- Starting dose: 10 mg three times daily to minimize QT prolongation risk 1
- Maximum dose: 20 mg three to four times daily 1
- Duration of action: 7-14 hours per dose with a plasma half-life of approximately 7.5 hours 1
The three-times-daily dosing schedule is specifically designed to match the pharmacokinetic profile of immediate-release domperidone 1, 2.
Clinical Efficacy Evidence
All published efficacy data supports immediate-release formulations:
- Gastroparesis treatment: Domperidone demonstrates superior efficacy compared to placebo and has a lower risk of extrapyramidal side effects than metoclopramide 1, 3
- Functional dyspepsia: Effective symptom control with immediate-release formulation 1
- Chemotherapy-induced nausea: 20 mg administered 3-4 times daily shows efficacy 1
- Long-term high-dose therapy: Studies using 40-120 mg/day of immediate-release domperidone showed 82% improvement in vomiting and 55% improvement in nausea over a mean duration of 52.3 months 4
Safety Considerations
Cardiac monitoring applies to all domperidone formulations:
- Avoid doses above 10 mg three times daily when possible to minimize QT prolongation and torsade de pointes risk 1
- ECG monitoring is warranted, especially in patients with other QT prolongation risk factors 1, 5
- Regular QTc monitoring is recommended for long-term therapy 5
Clinical Recommendation
Use immediate-release domperidone at 10 mg three times daily as the starting regimen, as this is the only formulation with established efficacy and safety data in gastroenterology guidelines 1. If an SR formulation is being considered, recognize that:
- No guideline-level evidence supports its use
- Dosing equivalence to immediate-release formulations is not established
- The pharmacokinetic profile may not align with the 7-14 hour duration of action needed for symptom control 1
The immediate-release formulation remains the evidence-based standard of care for all approved indications including gastroparesis, functional dyspepsia, and chemotherapy-induced nausea 1, 6.