Domperidone (Paediatric)

How it works

It blocks dopamine D2 receptors in the chemoreceptor trigger zone and upper gut, reducing nausea and enhancing gastric emptying, while largely not crossing the blood-brain barrier.

Prescribing in practice

• Domperidone can prolong the QT interval and cause serious ventricular arrhythmias, so it is contraindicated in cardiac conduction disorders, significant electrolyte disturbance and with other QT-prolonging or interacting drugs, and should be used at the lowest effective dose for the shortest time.
• It is contraindicated in moderate to severe hepatic impairment and where prokinetic action could be harmful, such as gastrointestinal obstruction or bleeding.
• Use only when other measures are inappropriate, dosing by body weight with a children's formulary.

Monitoring

Assess cardiac risk before starting, correct electrolytes, and review the ongoing need regularly given the QT prolongation risk.

Counselling the patient

• Stop the medicine and seek help if palpitations, fainting or an irregular heartbeat occur.
• Use it only for as long as advised and avoid combining with other medicines unless checked.
• Tell the team about any heart problems or family history of sudden cardiac death.

Evidence & guidelines

An MHRA review led to restricted indications and reinforced contraindications for domperidone owing to a small increased risk of serious cardiac side effects.