What is the recommended domperidone dosage for a 1‑year‑old child weighing approximately 10 kg?

Domperidone Dosing for a 1-Year-Old Child

For a 1-year-old child weighing approximately 10 kg, domperidone should be dosed at 0.25 mg/kg three times daily (2.5 mg per dose, 7.5 mg total daily), though recent evidence questions its efficacy in pediatric gastroenteritis and cardiac safety concerns warrant careful consideration of alternative antiemetics. 1

Evidence-Based Dosing Recommendations

Standard Pediatric Dose

• The most recent high-quality pediatric trial used 0.25 mg/kg three times daily in children aged 6 months to 12 years, which translates to approximately 2.5 mg per dose (7.5 mg total daily) for a 10 kg child 1
• This low-dose regimen was specifically designed to minimize cardiac risks while maintaining potential therapeutic benefit 1
• Treatment duration should be limited to 2-7 days maximum to reduce adverse event risk 1

Alternative Dosing from Clinical Practice

• An older dosing strategy used 0.5 mg/kg per dose (5 mg per dose for a 10 kg child), but this higher dose carries increased cardiac risk and is not supported by recent evidence 2

Critical Safety Considerations

Cardiac Risks

• Domperidone has been associated with sudden cardiac death due to QT prolongation, particularly at doses exceeding 30 mg daily in adults 3
• While the 7.5 mg daily dose for a 10 kg child is well below concerning thresholds, vigilance for QT-prolonging drug interactions is essential 3
• No QT prolongation or extrapyramidal symptoms were reported in the recent pediatric trial using 0.25 mg/kg dosing 1

Drug Interactions to Avoid

• Avoid concurrent use with any of the >120 medications that prolong QT interval, as this dramatically increases risk of fatal arrhythmias 3
• Common pediatric QT-prolonging drugs include macrolide antibiotics (azithromycin, erythromycin), ondansetron, and certain antifungals 3

Efficacy Concerns and Alternative Therapy

Limited Evidence of Benefit

• A 2019 phase 3 randomized controlled trial found no significant difference between domperidone (0.25 mg/kg) and placebo for reducing vomiting episodes in pediatric acute gastroenteritis (32.0% vs 33.8% vomiting-free at 48 hours) 1
• The study was terminated early for futility, suggesting domperidone may not provide meaningful clinical benefit over oral rehydration therapy alone 1

Superior Alternative

• Ondansetron 0.15 mg/kg orally (1.5 mg for a 10 kg child) demonstrated significantly better vomiting cessation at 24 hours (95% vs 85%, p=0.01) compared to domperidone in head-to-head comparison 2
• Ondansetron is more efficacious and should be considered first-line for gastroenteritis-associated vomiting in this age group 2

Administration Algorithm

If domperidone is chosen despite limited efficacy:

1. Verify weight is accurate (approximately 10 kg for typical 1-year-old)
2. Calculate dose: 0.25 mg/kg = 2.5 mg per dose
3. Administer three times daily (every 8 hours)
4. Give before meals if possible to maximize gastric prokinetic effect
5. Limit treatment to maximum 7 days
6. Screen for QT-prolonging medications before initiation 3

Preferred alternative approach:

• Consider ondansetron 0.15 mg/kg (1.5 mg) as single dose, which can be repeated once if vomiting persists 2
• Emphasize oral rehydration therapy as primary treatment 1

Common Pitfalls to Avoid

• Do not use the 0.5 mg/kg dose cited in older literature, as this doubles cardiac risk without proven additional benefit 2, 1
• Do not extrapolate adult dosing (30 mg daily) to pediatrics using simple weight-based calculations, as drug elimination differs substantially in young children 4
• Do not continue beyond 7 days, as prolonged use increases adverse event risk without established benefit 1
• Do not assume efficacy based on mechanism of action alone—recent evidence shows domperidone performs no better than placebo for pediatric gastroenteritis 1