Domperidone Dosing for a 2-Year-Old Child Weighing 9.78 kg
For a 2-year-old weighing 9.78 kg, domperidone syrup should be dosed at 0.25 mg/kg per dose, given 3-4 times daily, which equals approximately 2.4-2.5 mg per dose (typically rounded to 2.5 mg per dose), with a maximum daily dose not exceeding 30 mg/day or 1 mg/kg/day. 1
Practical Dosing Calculation
- Weight-based calculation: 9.78 kg × 0.25 mg/kg = 2.45 mg per dose 1
- Practical dose: 2.5 mg per dose, administered 3-4 times daily 1
- Maximum daily dose: 10 mg/day (2.5 mg × 4 doses) for this child, well below the 30 mg/day safety threshold 1
Syrup Formulation and Administration
- Domperidone syrup is typically available as 1 mg/mL concentration 1
- For 2.5 mg per dose: Administer 2.5 mL of syrup per dose 1
- Timing: Give 15-30 minutes before meals and at bedtime if needed for 4 doses daily 2, 3
- Frequency: Every 6-8 hours, with doses timed before feeding to maximize prokinetic effect 2, 4
Critical Safety Considerations
- Cardiac monitoring: Although domperidone has minimal CNS penetration and lower extrapyramidal effects compared to metoclopramide, doses above 30 mg/day have been associated with cardiac arrhythmias in older patients 5
- This child's maximum daily dose of 10 mg is well within safe parameters 5
- Domperidone has been used successfully in pediatric populations without significant extrapyramidal side effects, unlike metoclopramide 2, 3
- The peripheral dopamine antagonist action provides antiemetic and gastroprokinetic effects without crossing the blood-brain barrier readily 2, 3
Duration and Monitoring
- Treatment duration should be limited to the shortest period necessary to control symptoms 1
- Monitor for rare prolactin-related effects (galactorrhea, gynecomastia), though these are uncommon in short-term pediatric use 4
- Assess clinical response after 2-4 weeks of therapy 4
Important Caveats
- Regulatory status: Domperidone is not FDA-approved in the United States but is widely used in many other countries 6
- The evidence base for pediatric domperidone dosing relies primarily on clinical experience and extrapolation from adult studies, as specific pediatric guidelines are limited 1
- Always verify local formulary availability and regulatory approval status before prescribing 1