Dopamine D2 Antagonist (Prokinetic) Pregnancy: Limited post-marketing data in pregnant women; animal studies show reproductive toxicity at maternally toxic doses. Use during pregnancy only when justified by the anticipated therapeutic benefit. Excreted in human milk (breast-fed infants receive less than 0.1% of the maternal weight-adjusted dose) — adverse effects, particularly cardiac effects, cannot be excluded; decide between discontinuing breast-feeding or domperidone, with caution where the breast-fed infant has QTc prolongation risk factors.

Domperidone

Brand names: Motilium

Domperidone is a dopamine-antagonist antiemetic and prokinetic used for nausea and vomiting; it acts mainly peripherally with little central penetration.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 ml of 1 mg/ml oral suspension (10 mg)

Route: Oral

Frequency: Up to three times per day, taken 15-30 minutes before meals

Max: 30 ml (30 mg) per day

Fetched SPC product is Domperidone 1 mg/ml Oral Suspension; the stated dose is for adults and adolescents 12 years of age and older weighing 35 kg or more. Use the lowest effective dose for the shortest duration necessary to control nausea and vomiting; usually the maximum treatment duration should not exceed one week. If taken after meals, absorption is somewhat delayed. Take each dose at the scheduled time; if a dose is missed, omit it and resume the usual schedule — do not double the dose. Higher risk of serious ventricular arrhythmia or sudden cardiac death in patients older than 60 years, on daily doses greater than 30 mg, or taking QT-prolonging drugs or CYP3A4 inhibitors. Hepatic impairment: contraindicated in moderate (Child-Pugh 7 to 9) or severe (Child-Pugh >9) impairment; no dose modification needed in mild (Child-Pugh 5 to 6) impairment. Paediatric: efficacy in children under 12 years of age has not been established, and efficacy in adolescents 12 years and older weighing less than 35 kg has not been established — no per-kg paediatric dose is stated; verify paediatric use against a children's formulary.

Dose adjustments

Renal

In severe renal impairment (serum creatinine >6 mg/100 ml, i.e. 0.6 mmol/l) the elimination half-life is prolonged — reduce the dosing frequency to once or twice daily depending on the severity of impairment, and the dose may need to be reduced. Review such patients regularly.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known hypersensitivity to domperidone or any of the excipients
Prolactin-releasing pituitary tumour (prolactinoma)
Confirmed or suspected phaeochromocytoma (risk of severe hypertensive episodes)
Where stimulation of gastric motility could be harmful, e.g. gastrointestinal haemorrhage, mechanical obstruction or perforation
Moderate or severe hepatic impairment
Known existing prolongation of cardiac conduction intervals, particularly QTc, significant electrolyte disturbances, or underlying cardiac disease such as congestive heart failure
Co-administration with QT-prolonging drugs, with the exception of apomorphine
Co-administration with potent CYP3A4 inhibitors, regardless of their QT-prolonging effects

Side effects

Dry mouth (common)
Somnolence and headache
QTc prolongation, torsade de pointes, ventricular arrhythmias and sudden cardiac death
Extrapyramidal disorder, oculogyric crisis, convulsion
Blood prolactin increased, galactorrhoea, gynaecomastia, breast pain or tenderness, amenorrhoea
Rash, pruritus, urticaria, angioedema; anaphylactic reaction including anaphylactic shock

Interactions

QT-prolonging drugs — contraindicated, except apomorphine, which may only be co-administered if the benefit outweighs the risk and the precautions in the apomorphine SmPC are strictly fulfilled
Potent CYP3A4 inhibitors — contraindicated regardless of their QT-prolonging effects
QT-prolonging drugs or CYP3A4 inhibitors — associated with a higher risk of serious ventricular arrhythmias and sudden cardiac death
Levodopa — plasma levodopa concentration increased (maximum 30-40%), although no dosage adjustment of levodopa is deemed necessary

Clinical monograph

How it works

It blocks peripheral dopamine D2 receptors (and at the chemoreceptor trigger zone) while crossing the blood-brain barrier poorly, so it causes fewer central extrapyramidal effects than metoclopramide.

Prescribing in practice

It prolongs the QT interval and carries a cardiac risk — restricted to short-term use at the lowest effective dose.
Avoid in cardiac disease, significant electrolyte disturbance, and with QT-prolonging drugs or strong CYP3A4 inhibitors (MHRA).
Reassess the need to continue.

Monitoring

Consider ECG and electrolytes where cardiac risk applies; limit the duration of use.

Counselling the patient

Use it only for the short course prescribed.
Tell your clinician about heart problems or other medicines.

Evidence & guidelines

Short-term antiemetic restricted by MHRA because of cardiac (QT) risk.

Reference: MHRA Drug Safety Update (2014) — Domperidone cardiac risk; EMA Domperidone Review 2014; NICE CKS Nausea/Vomiting; SPC Motilium; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways