domperidone maleate: clinical use

Prescribing considerations

• Confirm nausea or vomiting as the treatment target and review the cause.
• Assess cardiac history, QT risk, electrolyte disturbance and all medicines and complementary products.
• Review hepatic and renal function; severe renal impairment prolongs elimination and warrants regular review.
• The selected formulation contains aspartame and releases phenylalanine.

Contraindications and cautions

• Hypersensitivity to domperidone or an excipient
• Confirmed or suspected phaeochromocytoma
• Prolactinoma
• Gastrointestinal haemorrhage, mechanical obstruction or perforation where increased motility could be harmful
• Moderate or severe hepatic impairment
• Known QT prolongation, significant electrolyte disturbance, bradycardia or significant cardiac disease such as heart failure
• Concurrent QT-prolonging medicines or potent CYP3A4 inhibitors, subject to the specified apomorphine exception

Monitoring

• Immediately review new palpitations, syncope or other possible arrhythmia symptoms.
• For off-label lactation use with cardiac risk factors, ECG monitoring may be required or an alternative considered.
• Regularly review people with severe renal impairment.
• Consider prolactin-related effects such as breast symptoms, galactorrhoea or menstrual disturbance.

Clinical pharmacology

A predominantly peripheral dopamine-receptor antagonist with antiemetic and gastrokinetic effects. Oral bioavailability is low because of extensive first-pass metabolism. It is mainly metabolised through CYP3A4, crosses the blood–brain barrier poorly and has prolonged elimination in severe renal impairment.

Formulation and product differences

• Epzit is an orodispersible tablet that disintegrates on the tongue and may be swallowed with or without water.
• It has a peppermint odour and contains mannitol and aspartame; aspartame provides phenylalanine.
• Keep it in the original pack to protect it from moisture.

Dispersible tablet

Route: Oral

Strengths: 10 mg