From the Guidelines
For patients with hepatitis who require domperidone, the recommended dosage is typically 10 mg orally three times daily before meals, with a maximum daily dose of 30 mg, as suggested by the most recent study 1. When considering the use of domperidone in hepatitis patients, it's crucial to prioritize their morbidity, mortality, and quality of life. The liver's role in metabolizing domperidone necessitates careful dose adjustment in patients with hepatic impairment.
- Key considerations include:
- Starting dose: 10 mg three times a day
- Maximum daily dose: 30 mg
- Dose adjustment for moderate to severe hepatic dysfunction: reduction by 50% to 5 mg three times daily or 10 mg twice daily
- Limited treatment duration: shortest time necessary, generally not exceeding one week
- Potential side effects to monitor include extrapyramidal symptoms, QT prolongation, and cardiac arrhythmias, as noted in the study 1.
- Concomitant use of medications that prolong the QT interval or inhibit CYP3A4 enzymes should be avoided due to the increased risk of adverse cardiac events, as domperidone can have cardiovascular risks, including QT prolongation and ventricular tachycardia, as mentioned in the study 1.
- Regular monitoring of liver function tests is advisable during treatment to ensure the safe use of domperidone in hepatitis patients.
From the Research
Doses of Domperidone in Hepatitis Patients
- The ideal dose of domperidone for hepatitis patients is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the study on domperidone: review of pharmacology and clinical applications in gastroenterology 4 mentions that domperidone is widely used in many countries and can be officially prescribed to patients in the United States by an investigational new drug application for the treatment of gastroparesis and any condition causing chronic nausea and vomiting.
- The pharmacokinetics and dose proportionality of domperidone in healthy volunteers study 5 found that the mean oral clearance (CL/F) after the solution dose was 4,735 +/- 2,017 mL/min and the mean apparent volume of distribution (Vd/F) was 6,272 +/- 5,100 L, indicating an extensive distribution of domperidone in the body.
- The same study 5 also found that dose proportionality of domperidone was observed in 12 subjects at solution doses of 10,20, and 40 mg, with linear correlations between the dose and Cmax and AUC values.
- The comparative evaluation of the efficacy and tolerability of itopride hydrochloride and domperidone in patients with non-ulcer dyspepsia study 3 used a dose of 10mg of domperidone three times daily for two weeks.
Hepatitis and Domperidone
- There is no direct evidence in the provided studies on the use of domperidone in hepatitis patients 2, 3, 4, 5, 6.
- However, the study on methotrexate-associated liver toxicity in a patient with breast cancer 6 mentions that liver toxicity can be a concern in patients with certain medical conditions, but it does not provide information on the use of domperidone in hepatitis patients.
- The study on successful administration of metoclopramide for the treatment of nausea in patients with advanced liver disease 2 used a different medication, metoclopramide, and found that it was safe and effective for treating nausea in patients with advanced liver disease.