Domperidone Dosing in Pediatric Patients
The recommended dosage of domperidone for children is 0.2-0.3 mg/kg per dose given three times daily, with a maximum daily dose not exceeding 30 mg, based on available pediatric guidelines and safety considerations. 1
Standard Dosing Regimens
Age-Based Dosing
- Infants: 0.2 mg/kg three times daily before meals 1
- Children (1 month to 12.7 years): 2 mg/kg/day divided into four doses daily 1
- Alternative regimen: 0.3 mg/kg three times daily before meals has been used in chronic vomiting/regurgitation 2
Indication-Specific Dosing
For chemotherapy-induced nausea and vomiting in pediatric oncology patients, the optimal dose appears to be 0.7 mg/kg per dose 3. This higher dose demonstrated reasonable to good control in 81% of treatment courses in this specific population 3.
Critical Safety Considerations
Maximum daily dose should not exceed 30 mg following the 2014 safety warning regarding cardiac adverse effects in children 4. After this warning was issued in South Korea, prescribing patterns appropriately shifted toward lower maximum daily doses 4.
Duration of Treatment
- Maximum continuous prescription period should not exceed 7 days 4
- Following safety warnings, the number of prescriptions exceeding 7 days significantly decreased, reflecting improved safety practices 4
Drug Interactions
Avoid co-prescribing medications that interact with domperidone, particularly those that prolong QT interval or inhibit CYP3A4 metabolism 4. The frequency of interacting medication co-prescriptions appropriately decreased after safety warnings were issued 4.
Administration Considerations
Route and Formulation
- Domperidone is typically administered as oral syrup (1% drops) in pediatric patients 2
- For intravenous administration (when used in oncology settings), adequate dilution is essential to prevent pain at the injection site 3
Timing
Administer doses before meals (three times daily) for optimal effect in treating chronic vomiting and regurgitation 2
Efficacy Evidence
The evidence supporting domperidone efficacy in children is limited and dated. A 1979 study showed domperidone was significantly more effective than both placebo and metoclopramide for chronic vomiting/regurgitation at 0.3 mg/kg three times daily 2. However, no recent high-quality evidence supports its efficacy in pediatric patients 1.
An uncontrolled 2006 study reported 64.5% improvement in infants and 100% improvement in older children, but this lacks the rigor of controlled trials 1.
Common Pitfalls to Avoid
- Do not exceed 30 mg maximum daily dose regardless of weight-based calculations 4
- Do not prescribe for longer than 7 days continuously without reassessment 4
- Ensure adequate dilution for IV administration to prevent injection site pain 3
- Screen for cardiac risk factors and QT-prolonging medications before prescribing 4
- Note that domperidone showed no benefit for functional constipation in children, so avoid this indication 5
Clinical Context
Following the 2014 safety warning, domperidone prescribing in pediatrics decreased by 30%, with improved safety practices including lower doses, shorter treatment durations, and fewer drug interactions 4. This reflects appropriate risk-benefit consideration given the limited high-quality efficacy data and potential cardiac risks 1, 4.