What is the recommended dose of domperidone (antiemetic medication) for a 1 year 11 month old child weighing 9.780 kg?

Domperidone Dosing for a 1 Year 11 Month Old Child (9.780 kg)

Critical Limitation

No established pediatric dosing guidelines for domperidone exist in the provided evidence, and the medication lacks FDA approval for use in children in the United States. 1

Evidence-Based Approach

Absence of Specific Pediatric Guidelines

• The available guideline evidence explicitly states that no specific dosing information for domperidone is available for pediatric patients 1
• Current recommendations advise consulting the FDA-approved drug label or product monograph for safe prescribing 1
• Institutional pediatric dosing protocols and pediatric gastroenterology references should be consulted before prescribing 1

General Pharmacologic Context

• Domperidone is a dopamine-2 receptor antagonist that acts as an antiemetic and prokinetic agent 2
• Unlike metoclopramide, it has minimal blood-brain barrier penetration, reducing extrapyramidal side effects 3, 2
• The medication has been used in children for cytotoxic-induced and postprandial nausea/vomiting without evidence of extrapyramidal side effects 3

Safety Considerations for This Age Group

• Cardiac safety is a significant concern: doses above 30 mg/day in adults have been associated with arrhythmias and sudden death, particularly in patients over 60 years 4
• The safety profile in very young children (under 2 years) is not well-established in the provided evidence 1
• Long-term use (up to 12 years) has been documented as well-tolerated in adult diabetic gastropathy patients at doses of 40-120 mg/day 5

Practical Recommendation

Given the absence of established pediatric dosing guidelines and the lack of FDA approval for this age group, domperidone should not be prescribed for this child without:

• Direct consultation with a pediatric gastroenterologist 1
• Review of institutional pediatric dosing protocols 1
• Access to country-specific product monographs where domperidone is approved for pediatric use 1
• Consideration of alternative antiemetic agents with established pediatric dosing 1

Common Pitfall to Avoid

• Do not extrapolate adult dosing (0.25-0.5 mg/kg/dose) without specialist guidance, as cardiac safety data in young children is insufficient 4, 1