domperidone (in association with dopamine agonists)

Last reviewed 01/2021

• domperidone can be taken with dopamine agonists to reduce nausea
  
  
• domperidone does not cross the blood-brain barrier and does not aggravate parkinsonism - in contrast to other antiemetics such as metoclopramide and prochlorperazine
  
  
• domperidone is associated with a small increased risk of serious cardiac side effects
  • its use is now restricted to the relief of nausea and vomiting and the dosage and duration of use have been reduced
  • should no longer be used for the treatment of bloating and heartburn
  • domperidone is now contraindicated in those with underlying cardiac conditions and other risk factors (see below). Patients with these conditions and patients receiving long-term treatment with domperidone should be reassessed at a routine appointment, in light of the new advice

Advice for Health Professionals following acknowledgement of increased risk of cardiac side effects with domperidone use (2):

• Indication
  • Domperidone is now restricted to use in the relief of nausea and vomiting It should be used at the lowest effective dose for the shortest possible time
    
    
• Contraindications
  • Domperidone is now contraindicated in people:
    • with conditions where cardiac conduction is, or could be, impaired
    • with underlying cardiac diseases such as congestive heart failure
    • receiving other medications known to prolong QT interval or potent CYP3A4 inhibitors
    • with severe hepatic impairment
      
      
• Duration of treatment
  • the maximum treatment duration should not usually exceed one week
  • patients currently receiving long-term treatment with domperidone should be reassessed at a routine appointment to advise on treatment continuation, dose change, or cessation

Patients with these conditions should have their treatment reviewed at their next routine appointment and be switched to an alternative treatment if required

Check the summary of product characteristics of domperidone before prescribing.

Reference:

• Prescribers' Journal (1999), 39 (3), 166-172.
• MHRA (May 2015).Domperidone: risk of cardiac side effects - restricted indication, new contraindications, and reduced dose and duration of use