Domperidone

Domperidone is a antiemetic / prokinetic (dopamine antagonist) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Nausea and vomiting in adults and, per doctor, in children
• Functional dyspepsia with early fullness, bloating and belching
• Gastroparesis (delayed stomach emptying), including diabetic gastroparesis
• Reflux symptoms when slow gastric emptying contributes, as judged by a doctor
• Nausea associated with some medicines, for example during migraine, when prescribed

The dose of Domperidone must be set by a registered doctor. For adults, the commonly used range of domperidone is 10 mg up to three times daily, taken 15-30 minutes before meals. Current safety guidance is to use the lowest effective dose for the shortest possible time, generally not exceeding one week of continuous use without medical review, because higher doses and longer use increase heart-rhythm (QT) risk.

For children, dosing is weight-based and decided only by a doctor; routine use in small children is discouraged in many guidelines. Do not double up missed doses, and never exceed the prescribed daily total of Domperidone.

Domperidone is usually well tolerated at recommended doses. Common side effects include dry mouth, headache, abdominal cramps and diarrhoea. Because it raises the hormone prolactin, some users notice breast tenderness, milk secretion or menstrual irregularity; these settle after stopping the medicine.

Rare but important effects involve the heart: domperidone can prolong the QT interval and, at high doses, in older patients or with interacting medicines, may trigger serious rhythm disturbance. Movement-related side effects such as muscle spasms or restlessness are rare, occurring mainly in children. Seek urgent care for palpitations, fainting, seizure-like episodes or severe allergic reactions.

Use domperidone cautiously and only under medical advice if you are over 60, have any heart disease, a history of rhythm problems or congenital long QT, or abnormal blood potassium or magnesium levels, as these increase the risk of serious arrhythmia. Tell your doctor about kidney or liver problems; doses may need reduction in kidney impairment.

Keep treatment short — typically up to one week unless your doctor specifically advises longer — and never combine it with other QT-prolonging medicines or strong CYP3A4 inhibitors. If vomiting persists, recurs or comes with severe pain, blood, drowsiness or dehydration, stop self-managing and get medical assessment promptly.

Do not take domperidone with medicines that prolong the QT interval or raise its blood level. Important examples include the antifungals ketoconazole, itraconazole, fluconazole and voriconazole; macrolide antibiotics such as erythromycin and clarithromycin; some antiarrhythmics (amiodarone); certain antipsychotics and antidepressants; and HIV protease inhibitors.

Grapefruit juice can also raise domperidone levels and is best avoided. Anticholinergic medicines may blunt its prokinetic effect, and it can alter the absorption of some other drugs by speeding stomach emptying. Always tell your doctor and pharmacist about every medicine, supplement and herbal product you use before starting domperidone.

Domperidone is contraindicated in people with known allergy to it, in moderate or severe liver impairment, and in anyone with existing QT prolongation, significant electrolyte disturbance or heart disease such as heart failure. It must not be combined with QT-prolonging drugs or strong CYP3A4 inhibitors such as ketoconazole or erythromycin.

It is also contraindicated where stimulating stomach movement is dangerous: gastrointestinal bleeding, mechanical obstruction or perforation. It should not be used in prolactin-secreting pituitary tumour (prolactinoma). Use in pregnancy, infants and the elderly requires specific medical judgement rather than routine use.

Pregnancy: Data on domperidone in pregnancy are limited. It should be used only when a doctor judges the expected benefit to outweigh potential risk, at the lowest dose for the shortest time. Safer-established measures for pregnancy nausea are usually preferred first.

Lactation: Small amounts pass into breast milk. Although domperidone raises prolactin, it is not an approved or routine way to increase milk supply, and infant heart-rhythm risk cannot be fully excluded. Breastfeeding mothers should use it only on medical advice, especially if the baby was premature or has heart problems.

Store below 30°C in a dry place away from direct sunlight and moisture. Keep the in its original packaging until use, and keep suspension bottles tightly closed; shake well before each use and discard as directed after opening. Keep out of the reach and sight of children. Do not use after the expiry date printed on the pack.