Dopamine D2 Antagonist (Prokinetic)
Pregnancy: Avoid — limited human data; risk of cardiac arrhythmia in neonate; metoclopramide or ondansetron preferred in pregnancy
Domperidone
Brand names: Motilium
Adult dose
Dose: 10 mg up to three times daily before meals
Route: Oral
Frequency: Up to three times daily (before meals and at bedtime if needed)
Max: 30 mg/day; maximum treatment duration 7 days (MHRA 2014 restriction)
Nausea and vomiting only — NO longer indicated for gastroparesis or dyspepsia (MHRA 2014); use lowest effective dose for shortest duration; contraindicated >70 years old (cardiac risk)
Paediatric dose
Dose: 0.25 mg/kg up to three times daily mg/kg
Route: Oral
Frequency: Up to three times daily
Max: 0.75 mg/kg/day (max 30 mg/day)
Paediatric use: limited to nausea/vomiting only; same 7-day maximum; caution — higher relative exposure in children due to immature blood-brain barrier
Dose adjustments
Renal
Reduce dosing frequency in renal impairment (prolonged half-life)
Hepatic
Contraindicated in moderate-severe hepatic impairment
Paediatric weight-based calculator
Paediatric use: limited to nausea/vomiting only; same 7-day maximum; caution — higher relative exposure in children due to immature blood-brain barrier
Clinical pearls
- MHRA 2014 restricted prescribing: following EMA pharmacovigilance review, domperidone associated with serious cardiac arrhythmias and sudden death — maximum dose reduced to 10 mg three times daily (previously 20 mg), restricted to 7 days, contraindicated >70 years (higher cardiac risk at older age)
- Unlike metoclopramide: domperidone does NOT cross blood-brain barrier significantly — fewer extrapyramidal side effects (dystonia, akathisia, tardive dyskinesia); but hyperprolactinaemia occurs due to action on pituitary (outside BBB); preferred over metoclopramide in Parkinson's disease patients (does not worsen parkinsonism)
- Parkinson's disease nausea: dopamine agonists (levodopa, ropinirole) cause nausea — domperidone is the antiemetic of choice as it does not block central dopamine receptors; use lowest dose for shortest duration given MHRA cardiac restrictions
- OTC availability: domperidone 10 mg is available OTC in UK for adults — pharmacists must screen for cardiac risk factors, drug interactions, and age >70; patient advice on duration limit is critical
- Do NOT use for gastroparesis: despite traditional use, MHRA 2014 removed this indication — prokinetic use for gastroparesis is now unlicensed; metoclopramide (7-day maximum) or erythromycin (prokinetic dose) are alternatives
Contraindications
- QTc prolongation or risk factors for QTc prolongation
- Hypokalaemia, hypomagnesaemia (QTc risk)
- Concurrent use of QTc-prolonging drugs
- Age >70 years (MHRA 2014)
- Moderate-severe hepatic impairment
- Known pituitary tumour secreting prolactin (prolactinoma)
Side effects
- QTc prolongation and arrhythmia (dose-dependent — MHRA 2014 cardiac safety review)
- Hyperprolactinaemia (galactorrhoea, amenorrhoea, gynaecomastia)
- Dry mouth
- Headache
- Diarrhoea
Interactions
- QTc-prolonging drugs (azithromycin, haloperidol, amiodarone) — additive QTc risk; CONTRAINDICATED combination
- CYP3A4 inhibitors (ketoconazole, clarithromycin) — increase domperidone levels; increased cardiac risk; avoid
- Anticholinergics — antagonise prokinetic effect
Monitoring
- ECG (baseline in at-risk patients)
- Electrolytes (K+, Mg2+ — correct before starting)
- Symptom resolution (reassess at 7 days)
- Prolactin if galactorrhoea or menstrual disturbance
Reference: BNFc; BNF 90; MHRA Drug Safety Update (2014) — Domperidone cardiac risk; EMA Domperidone Review 2014; NICE CKS Nausea/Vomiting; SPC Motilium. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.