Domstal Dosing for 10-Month-Old Infant (7.8 kg)
The recommended dose of Domstal (domperidone) for a 10-month-old infant weighing 7.8 kg is 0.25 mg/kg per dose, given 3-4 times daily, which equals approximately 2 mg per dose (total daily dose: 6-8 mg/day). This weight-based dosing approach is supported by pediatric gastroenterology literature and provides an appropriate balance between efficacy and safety for this age group 1, 2.
Specific Dosing Calculation
- Weight-based calculation: 7.8 kg × 0.25 mg/kg = 1.95 mg per dose (round to 2 mg for practical administration) 1
- Frequency: Administer 3-4 times daily, preferably 15-30 minutes before feeds 2
- Maximum daily dose: Should not exceed 0.8-1.0 mg/kg/day (approximately 6-8 mg/day for this infant) 1
- Minimum interval: Maintain at least 6-8 hours between doses if giving 3 times daily 2
Formulation and Administration
- Domstal is typically available as oral suspension (1 mg/mL) or tablets (10 mg) 2
- For this infant, use the oral suspension formulation: give 2 mL per dose from the 1 mg/mL suspension 1
- Administer 15-30 minutes before feeds to optimize prokinetic effects 2
- Can be given with or without food, though pre-meal administration is preferred for gastroprokinetic indications 2
Clinical Indications and Duration
Domperidone is used off-label in infants for:
Treatment duration should be limited to the shortest period necessary (typically 2-4 weeks initially), with reassessment of continued need 1. Long-term use beyond 12 weeks requires careful risk-benefit evaluation 1.
Critical Safety Considerations
Cardiac Safety
- QT prolongation risk: Domperidone can prolong the QT interval, particularly at doses exceeding 30 mg/day in adults (proportionally lower in children) 4
- For this 7.8 kg infant, the recommended daily dose of 6-8 mg/day is well below the threshold associated with significant cardiac risk 4
- Avoid concurrent use with other QT-prolonging medications 4
Contraindications and Precautions
- Do not use if the infant has known cardiac arrhythmias or significant cardiac disease 4
- Avoid in patients with hepatic impairment (domperidone is extensively metabolized by the liver) 2
- Monitor for prolactin-related effects (rare in short-term use at therapeutic doses) 5
Advantages Over Alternatives
- Superior safety profile compared to metoclopramide: Domperidone has minimal blood-brain barrier penetration, resulting in significantly lower risk of extrapyramidal side effects (dystonia, tardive dyskinesia) that are concerning with metoclopramide in infants 3, 2
- Well-tolerated in pediatric populations with appropriate dosing 3, 1
Monitoring Parameters
- Assess clinical response (reduction in vomiting, improved feeding tolerance) after 1-2 weeks 1
- Monitor for adverse effects: irritability, diarrhea (uncommon at therapeutic doses) 3
- If no improvement after 2-4 weeks at maximum dose, consider alternative diagnoses or therapies 1
- Reassess need for continued therapy regularly; discontinue if symptoms resolve 1
Important Clinical Caveat
Off-label use: Domperidone is not FDA-approved for use in infants in the United States and requires an investigational new drug (IND) application for prescription 2. In many other countries, it is available but still used off-label in this age group 1. The prescription should be made with full informed consent from parents/caregivers regarding the off-label nature and potential risks, particularly cardiac effects 1, 4.