Domperidome

# domperidome ## Overview - **Classification**: Dopamine D2 receptor antagonist, Prokinetic agent. - **Mechanism**: Blocks dopamine D2 receptors in the chemoreceptor trigger zone and gastric wall. This increases gastric motility and tone of the lower esophageal sphincter. ## Primary Indications 1. **Nausea and Vomiting** - Symptomatic relief of nausea and vomiting. 2. **Gastroparesis** - Relief of symptoms associated with chronic delayed gastric emptying (off-label in some regions). ## Adult Dosing ### Standard Dosing **Nausea and Vomiting / Gastroparesis** - **Dose**: **10 mg** - **Frequency**: Up to **3 times daily** - **Route**: Oral - **Duration**: Shortest possible; typically **≤7 days** for acute nausea/vomiting. - **Maximum daily dose**: **30 mg/day**. ### Dose Adjustments - **Renal Impairment**: - CrCl < 30 mL/min: Reduce frequency to **1-2 times daily**. - Consider reducing individual dose by 30-50%. - **Hepatic Impairment**: - Moderate to severe (Child-Pugh B or C): **Contraindicated**. - Mild (Child-Pugh A): No dose adjustment. - **Elderly Patients**: - Use lowest effective dose. - Increased risk of cardiac adverse effects; monitor closely. ## Pediatric Dosing *Note: Domperidone is generally restricted or contraindicated in pediatric patients in many regions (e.g., US, Canada) due to cardiac safety concerns. Use only if clearly indicated and under strict medical supervision.* ### Neonates (0-28 days) - **Not recommended** due to significant cardiac risk (QTc prolongation). - If used for severe, refractory cases: **0.2-0.3 mg/kg/dose** - Frequency: Every **6-8 hours** - Maximum: **0.3 mg/kg/dose** or **2.5 mg/dose** - Special Notes: Requires intensive cardiac monitoring (ECG). ### Infants (1-12 months) - **Not recommended** for routine use. - If used for severe refractory conditions: **0.2-0.3 mg/kg/dose** - Frequency: Every **6-8 hours** - Maximum: **0.3 mg/kg/dose** or **5 mg/dose** - Special Notes: Monitor ECG closely due to QTc prolongation risk. ### Children (1-12 years) - **Not recommended** for routine use. - For severe, refractory cases: **0.2-0.3 mg/kg/dose** - Frequency: Every **6-8 hours** - Maximum: **0.3 mg/kg/dose** or **10 mg/dose** (total daily max **30 mg/day**). ### Adolescents (13-18 years) - Follow adult dosing guidelines: **10 mg** - Frequency: Up to **3 times daily** - Maximum: **30 mg/day** - Special Notes: Evaluate cardiac risk factors. ## Safety Information ### Contraindications - **Absolute**: Known prolonged QT interval, significant electrolyte disturbances (hypokalemia, hypomagnesemia). - **Absolute**: Congestive heart failure, clinically significant bradycardia, recent myocardial infarction. - **Absolute**: Co-administration with potent CYP3A4 inhibitors (e.g., ketoconazole, erythromycin). - **Absolute**: Prolactin-secreting pituitary tumor. - **Absolute**: Moderate to severe hepatic impairment (Child-Pugh B or C). - **Absolute**: GI hemorrhage, mechanical obstruction, perforation. ### Common Adverse Effects - **Common (1-10%)**: Dry mouth, headache, abdominal cramps, diarrhea. - **Less Common**: Galactorrhea, breast tenderness/enlargement, amenorrhea (due to prolactin elevation). - **Serious but Rare**: **Cardiac arrhythmias** (ventricular arrhythmias, Torsades de Pointes), sudden cardiac death, extrapyramidal symptoms (very rare, more common in children). ### Key Drug Interactions - **Potent CYP3A4 Inhibitors (e.g., ketoconazole, erythromycin, clarithromycin, ritonavir)**: **Contraindicated**. Significantly increase domperidone levels and cardiac risk. - **QT-prolonging Drugs (e.g., antiarrhythmics, antipsychotics, certain antidepressants)**: **Avoid concomitant use**. Additive risk of QTc prolongation. - **Anticholinergics**: May antagonize the prokinetic effect. - **Antacids/H2 blockers/PPIs**: Reduce domperidone bioavailability. Administer domperidone before meals. ## Monitoring & Follow-up - **Before Treatment**: Assess cardiac risk factors (ECG if indicated), baseline electrolytes (K+, Mg2+). - **During Treatment**: Monitor for signs of cardiac arrhythmias (e.g., palpitations, syncope). Re-evaluate therapy need. - **Clinical Signs**: Watch for dry mouth, headache, abdominal discomfort, and any cardiac symptoms. ## Clinical Pearls - 💡 **Cardiac Risk**: Domperidone has a **Black Box Warning** in some regions due to the risk of serious ventricular arrhythmias and sudden cardiac death, especially at higher doses or with risk factors. - 💡 **Administration Timing**: Administer **15-30 minutes before meals** for optimal prokinetic effect. - 💡 **Short-Term Use**: Use the **lowest effective dose** for the **shortest possible duration**. Re-assess treatment benefit regularly. - 💡 **Pediatric Use**: Highly restricted or contraindicated in many countries due to serious cardiac risks. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.