Dr Sharon Rees @reesprescribe
Day 1: After recognition that early antipsychotic drugs acting on dopamine pathways had an impact on vomiting, the search was on for an anti-emetic without extra pyramidal side-effects (EPS). #domperidone was licensed in the 1970s
Dr Sharon Rees @reesprescribe
Day 2: Indications for #domperidone; relief of nausea/vomiting for those over 12 years & over 35kg. Dose 10mg up to three times/day for 1 week, including 2nd line for nausea/vomiting in pregnancy. Same dose used for GI pain in adult palliative care
Dr Sharon Rees @reesprescribe
Day 3: #domperidone has rapid oral absorption with high first pass metabolism in the gut & liver. High Vd (low concn in brain), hepatic phase 1 breakdown e.g CYP3A4 & 1A2. 2/3 faecal excretion with small amount unchanged. T½ 7-9hrs; prolonged if severe renal or hepatic impairment
Dr Sharon Rees @reesprescribe
Day 4: #domperidone has a dual anti-emetic effect via blocking dopamine receptors in the chemoreceptor trigger zone & accelerating gastric motility & emptying (pro-kinetic effect)
Dr Sharon Rees @reesprescribe
Day 5: Common ADEs: dry mouth. Uncommon: reduced libido, anxiety, headache, diarrhoea, breast pain. Unknown: anaphylactic reaction, convulsion, urinary retention, ventricular arrhythmia, sudden cardiac death, QT prolongation, Torsade de Pointes (NOT exhaustive)
Dr Sharon Rees @reesprescribe
Day 5 (cont): Extra pyramidal symptoms are less likely because #domperidone does not cross the blood brain barrier (BBB). However, the pituitary gland lies outside the BBB & therefore #domperidone can cause prolactin release (note can be used to stimulate breast milk off-label)
#Dr Sharon Rees @reesprescribe
Day 6: domperidone drug-drug interactions. All drugs which can lead to QT interval prolongation should be avoided e.g. lithium. Drugs which increase exposure e.g clarithromycin are marked as ‘severe’ interaction (NOT exhaustive)
Dr Sharon Rees @reesprescribe
Day 7: #domperidone was banned in the USA as an anti-emetic in 2004. This was because of concern about the risk of serious cardiac disorders. It may be used in USA as a gastro-prokinetic drug
Earn Your Cpd Certificate
With the help of Prescribing and Therapeutics Training Ltd and the Journal of Prescribing Practice, you can earn your 1-hour CPD certificate
In addition to the tweets, read the BNF treatment summaries on nausea and labyrinth disorders, as well as the monograph on domperidone and the SPC for domperidone. Once you have completed this, answer the 10 questions. Submit your answers to reesprescribe@gmail.com. If you answer at least eight out of 10 questions correctly, you will receive your CPD certificate via email.
- Domperidone is licensed for use as an anti-emetic in adults only TRUE or FALSE?
- Domperidone is used as a first-line drug in pregnancy-related emesis TRUE or FALSE?
- Domperidone slows gastric emptying TRUE or FALSE?
- Which of the following is TRUE?
- Domperidone has a high bioavailability
- Domperidone is predominantly broken down in the liver
- Domperidone has a very short half-life
- Domperidone is predominantly broken down in the gut
- Domperidone exerts its anti-emetic effect by stimulating dopamine receptors in the gut TRUE or FALSE?
- Which of the following is FALSE?
- Domperidone helps manage emesis by both its main actions
- Domperidone only acts on dopamine receptors
- Domperidone cannot be given if there is any renal impairment
- Domperidone has a role for gastro-intestinal pain in palliative care
- Domperidone is less likely to cause extra pyramidal side effects because it does not cross the blood brain barrier TRUE or FALSE?
- Which of the following is a common side-effect for domperidone?
- Breast pain
- Headache
- Convulsion
- Dry mouth
- Enzyme inhibitors such as fluconazole can have a severe drug drug interaction with domperidone TRUE or FALSE?
- Concerns about cardiac risk led to domperidone being banned in the USA TRUE or FALSE?
Further reading on #domperidone
- https://bnf.nice.org.uk/treatment-summaries/nausea-and-labyrinth-disorders/
- https://bnf.nice.org.uk/drugs/domperidone/
- https://www.medicines.org.uk/emc/product/556/smpc#gref