Domperidone

How it works

It blocks peripheral dopamine D2 receptors in the chemoreceptor trigger zone and upper gastrointestinal tract, promoting gastric emptying and suppressing nausea while largely sparing central effects as it poorly crosses the blood-brain barrier.

Prescribing in practice

• It prolongs the QT interval and is associated with serious ventricular arrhythmias and cardiac death, so it is contraindicated in significant cardiac disease, QT prolongation, electrolyte disturbance and with other QT-prolonging or strong CYP3A4-inhibiting drugs, and should be used at the lowest effective dose for the shortest time.
• It is contraindicated where stimulation of gut motility could be harmful, such as gastrointestinal obstruction, haemorrhage or perforation.
• Cardiac risk is greater in older patients and at higher doses, reinforcing short-duration use.

Monitoring

Assess cardiac and electrolyte risk before and during treatment, reviewing concomitant QT-prolonging and CYP3A4-inhibiting drugs and keeping the course short.

Counselling the patient

• Take this medicine for as short a time as possible to settle nausea and vomiting.
• Tell your prescriber about any heart problems or other medicines you take.
• Stop and seek urgent advice if you develop palpitations, fainting or an irregular heartbeat.

Evidence & guidelines

MHRA advice restricted domperidone to short-term symptomatic relief of nausea and vomiting at the lowest effective dose because of a small increased risk of serious cardiac side effects.