Dopamine D2 Antagonist (Peripheral) — Nausea / GORD / Gastroparesis in Children Pregnancy: Use with caution — limited data; domperidone excreted in breast milk; MHRA advises avoiding in breastfeeding

Domperidone (Paediatric)

Brand names: Motilium

Adult dose

Dose: 10 mg 3 times daily before meals (max 30 mg/day); max duration 1 week (MHRA restriction)

Route: Oral

Frequency: 3 times daily

Max: 30 mg/day; duration max 1 week

Adult reference — see paediatric dose section

Paediatric dose

Dose: 0.25 mg/kg 3 times daily before meals and at bedtime mg/kg

Route: Oral (suspension 1 mg/mL)

Frequency: 3–4 times daily

Max: 0.75 mg/kg/day; max 2.4 mg/kg/day (up to 30 mg/day for >35 kg)

BNFc: MHRA 2014 restriction — domperidone only licensed in children for nausea/vomiting; maximum duration 1 week. NOT recommended for GORD as sole treatment — limited evidence and QT risk. Use with caution: higher QT prolongation risk in children <1 year (immature hepatic CYP3A4 — higher plasma levels). Suspension 1 mg/mL available. Metoclopramide preferred alternative for acute vomiting in hospital (IV access), but domperidone preferred for community use (no EPS at peripheral doses).

Dose adjustments

Renal

Severe renal impairment: reduce to once or twice daily dosing

Hepatic

Contraindicated in moderate-severe hepatic impairment — hepatically metabolised

Paediatric weight-based calculator

Patient weight (kg)

Clinical pearls

MHRA 2014: domperidone dose halved and duration limited to 1 week — QT risk (Torsades de Pointes); use lowest effective dose; avoid in high-risk patients (cardiac disease, electrolyte abnormalities, QT-prolonging drugs)
Does not cross blood-brain barrier in significant amounts at standard doses — hence peripheral prokinetic effect without EPS (unlike metoclopramide); this makes it preferred for long-term paediatric use when appropriate
Infants under 1 year: CYP3A4 immaturity leads to 5× higher plasma levels than older children and adults — use with extreme caution; some centres avoid entirely
Off-label GORD use: widely used in paediatric GORD despite limited evidence and MHRA restrictions — clinical practice often diverges from labelling; document risk-benefit discussion

Contraindications

Hepatic impairment (moderate-severe)
GI haemorrhage, obstruction or perforation
Concurrent QT-prolonging drugs or conditions
Concurrent potent CYP3A4 inhibitors (ketoconazole, clarithromycin, erythromycin — dramatically increase domperidone levels)

Side effects

QTc prolongation (dose-dependent — most dangerous in neonates/young infants)
Hyperprolactinaemia (galactorrhoea, gynaecomastia)
Dry mouth
Headache
Rarely EPS (central D2 blockade minimal — does not cross BBB at standard doses)
Diarrhoea

Interactions

Potent CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin, erythromycin) — contraindicated (markedly increase domperidone QT risk)
QT-prolonging drugs — additive
Antifungals — avoid concurrent use

Monitoring

ECG (QTc) before initiation if cardiac risk factors or concurrent QT drugs
Electrolytes (hypokalaemia worsens QT risk)
Symptom response (vomiting frequency)
Prolactin if symptoms suggest hyperprolactinaemia

Reference: BNF for Children; MHRA Drug Safety Update 2014 (Domperidone QT Risk); NICE CG184 (GORD in Infants); ESPGHAN GORD Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways