domperidone: clinical use

Prescribing considerations

• Confirm licensed use or clearly document and explain non-licensed use.
• Assess eligibility, cardiac history, concomitant medicines, electrolyte disturbance, hepatic impairment, renal impairment and possible phaeochromocytoma.
• For lactation use, undertake a skilled feeding assessment and address reversible causes before considering pharmacological treatment.

Contraindications and cautions

• Hypersensitivity to domperidone or an excipient
• Prolactinoma
• Confirmed or suspected phaeochromocytoma
• Gastrointestinal haemorrhage, mechanical obstruction or perforation where increased motility could be harmful
• Moderate or severe hepatic impairment
• Known QTc prolongation, significant electrolyte disturbance, bradycardia or underlying cardiac disease such as congestive heart failure
• Concomitant QT-prolonging medicines, except tightly controlled apomorphine use
• Concomitant potent CYP3A4 inhibitors

Monitoring

• Review QT-prolonging medicines and CYP3A4 inhibitors before prescribing.
• Consider ECG and electrolyte assessment when cardiac risk factors are present; ECG monitoring is required with apomorphine.
• Review severe renal impairment regularly.
• Stop and assess promptly if palpitations, syncope or possible arrhythmia symptoms develop.

Clinical pharmacology

A peripheral dopamine D2-receptor antagonist with antiemetic and upper-gastrointestinal prokinetic activity. It crosses the blood–brain barrier poorly, is mainly metabolised through CYP3A4 and can increase prolactin.

Formulation and product differences

• The selected product is a 1 mg/mL white oral suspension.
• It contains sorbitol and is unsuitable for hereditary fructose intolerance.
• It contains methyl and propyl hydroxybenzoate, which can cause delayed allergic reactions.

Oral suspension

Route: Oral

Strengths: 1 mg/mL