Prescription medicine (Rx only):Pakistan, India, Australia, Canada, Israel, Belgium, France, Netherlands; over-the-counter: Egypt, Ireland, Italy, Japan, South Africa, Switzerland, Kuwait, China, Russia, Slovakia, Ukraine[2] Mexico, Thailand, Malta, South Korea, and Romania[3]
Domperidone, sold under the brand name Motilium among others, is a medication used to relieve nausea, increase the transit of food through the stomach, treat migraines, and to promote breast milk production.[1][6][7] It is taken by mouth.[8] Due to the risk of side effects, use is recommended for less than a week and it is not recommended to increase breast milk.[8][9]
Domperidone was developed in 1974 by Janssen Pharmaceutica.[12] It is available as a generic medication.[8] In the United Kingdom a months supply costs the NHS about 3 pounds.[8] While available in many countries, it is only available in the United States under compassionate use for severe gastrointestinal motility disorders not manageable by other treatments.[1][9]
Domperidone is indicated for nausea and vomiting.[13] It is recommended by the Canadian Headache Society for treatment of nausea associated with acute migraine.[14]
Gastroparesis is a medical condition characterised by delayed emptying of the stomach when there is no mechanical gastric outlet obstruction. Its cause is most commonly idiopathic, a diabetic complication or a result of abdominal surgery. The condition causes nausea, vomiting, fullness after eating, early satiety (feeling full before the meal is finished), abdominal pain and bloating.
However, increased rate of gastric emptying induced by drugs like domperidone does not always correlate (equate) well with relief of symptoms.[17]
Domperidone can be used to relieve gastrointestinal symptoms in Parkinson's disease; it blocks peripheral D2 receptors but does not cross the blood–brain barrier in normal doses (the barrier between the blood circulation of the brain and the rest of the body) so has no effect on the extrapyramidal symptoms of the disease.[18]
There is tentative evidence that domperidone moderately increases the volume of expressed breast milk in mothers of preterm babies where breast milk expression was inadequate.[19][20] Domperidone; however, is not approved for this use and such use is not recommended due to the risk of side effects.[6][21][22][9] A 2012 review found no studies support preventative use of a galactagogue medication at any gestation including domperidone.[23]
Domperidone has been found effective in the treatment of reflux in children.[24] However some specialists consider its risks prohibitory of the treatment of infantile reflux.[25]
The dose in those who weight more than 35 kg is generally 10 mg by mouth up to three times per day.[8] In those who weight less than that the dose is 0.25 mg per kg up to three times per day.[8]
Domperidone use is associated with an increased risk of sudden cardiac death (by 70%)[33] most likely through its prolonging effect of the cardiac QT interval and ventricular arrhythmias.[34][35] The cause is thought to be blockade of hERGvoltage-gated potassium channels.[36][37] The risks are dose-dependent, and appear to be greatest with high/very high doses via intravenous administration and in the elderly, as well as with drugs that interact with domperidone and increase its circulating concentrations (namely CYP3A4 inhibitors).[38][39] Conflicting reports exist, however.[40] In neonates and infants, QT prolongation is controversial and uncertain.[41][42]
UK drug regulatory authorities (MHRA) have issuedArchived 25 August 2018 at the Wayback Machine the following restriction on domperidone in 2014 due to increased risk of adverse cardiac effects:
Domperidone (Motilium) is associated with a small increased risk of serious cardiac side effects. Its use is now restricted to the relief of nausea and vomiting and the dosage and duration of use have been reduced. It should no longer be used for the treatment of bloating and heartburn. Domperidone is now contraindicated in those with underlying cardiac conditions and other risk factors. Patients with these conditions and patients receiving long-term treatment with domperidone should be reassessed at a routine appointment, in light of the new advice.
However, a 2015 Australian review concluded the following:[39]
Based on the results of the two TQT (the regulatory agency gold standard for assessment of QT prolongation) domperidone does not appear to be strongly associated with QT prolongation at oral doses of 20 mg QID in healthy volunteers. Further, there are limited case reports supporting an association with cardiac dysfunction, and the frequently cited case-control studies have significant flaws. While there remains an ill-defined risk at higher systemic concentrations, especially in patients with a higher baseline risk of QT prolongation, our review does not support the view that domperidone presents intolerable risk.
In healthy volunteers, ketoconazole increased the Cmax and AUC concentrations of domperidone by 3- to 10-fold.[44] This was accompanied by a QT interval prolongation of about 10–20 milliseconds when domperidone 10 mg four times daily and ketoconazole 200 mg twice daily were administered, whereas domperidone by itself at the dosage assessed produced no such effect.[44] As such, domperidone with ketoconazole or other CYP3A4 inhibitors is a potentially dangerous combination.[44]
A single 20 mg oral dose of domperidone has been found to increase mean serum prolactin levels (measured 90 minutes post-administration) in non-lactating women from 8.1 ng/mL to 110.9 ng/mL (a 13.7-fold increase).[29][49][50][51] This was similar to the increase in prolactin levels produced by a single 20 mg oral dose of metoclopramide (7.4 ng/mL to 124.1 ng/mL; 16.7-fold increase).[50][51] After two weeks of chronic administration (30 mg/day in both cases), the increase in prolactin levels produced by domperidone was reduced (53.2 ng/mL; 6.6-fold above baseline), but the increase in prolactin levels produced by metoclopramide, conversely, was heightened (179.6 ng/mL; 24.3-fold above baseline).[29][51] This indicates that acute and chronic administration of both domperidone and metoclopramide is effective in increasing prolactin levels, but that there are differential effects on the secretion of prolactin with chronic treatment.[50][51] The mechanism of the difference is unknown.[51] The increase in prolactin levels observed with the two drugs was, as expected, much greater in women than in men.[50][51] This appears to be due to the higher estrogen levels in women, as estrogen stimulates prolactin secretion.[52]
For comparison, normal prolactin levels in women are less than 20 ng/mL, prolactin levels peak at 100 to 300 ng/mL at parturition in pregnant women, and in lactating women, prolactin levels have been found to be 90 ng/mL at 10 days postpartum and 44 ng/mL at 180 days postpartum.[53][54]
1978 – On 3 January 1978 Domperidone was patented in the United States under patent US4066772 A. The application has been filed on 17 May 1976. Jan Vandenberk, Ludo E. J. Kennis, Marcel J. M. C. Van der Aa and others has been cited as the inventors.
1979 – Domperidone marketed under trade name "Motilium" in Switzerland and (Western) Germany.[62]
Janssen Pharmaceutical has brought domperidone before the United States Federal Drug Administration (FDA) several times, including in the 1990s.
2014 – In April 2014 Co-ordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh) published official press-release suggesting to restrict the use of domperidone-containing medicines. It also approved earlier published suggestions by Pharmacovigilance Risk Assessment Committee (PRAC) to use domperidone only for curing nausea and vomiting and reduce maximum daily dosage to 10 mg.[64]
In 2007 domperidone was available in 58 countries, including Canada.[68] The approved indications of domperidone vary between nations. In Italy it is used in the treatment of gastroesophageal reflux disease and in Canada, the drug is indicated in upper gastrointestinal motility disorders and to prevent gastrointestinal symptoms associated with the use of dopamine agonist antiparkinsonian agents.[69] In the United Kingdom, domperidone is only indicated for the treatment of nausea and vomiting and the treatment duration is usually limited to 1 week.
In the United States, domperidone is not currently generally approved for medical use. On 7 June 2004, FDA issued a public warning that distributing any domperidone-containing products is illegal.[70] There is an exception for use in people with treatment-refractory gastrointestinal symptoms under an FDA Investigational New Drug application.[1]
It is available over-the-counter to treat gastroesophageal reflux and functional dyspepsia in many countries, such as Ireland, the Netherlands, Italy, South Africa, Mexico, Chile, and China.[71]
↑"БРЮЛІУМ ЛІНГВАТАБС" [BRULIUM LINGUATABS]. Нормативно-директивні документи МОЗ України (in українська). 18 March 2014. Archived from the original on 30 May 2015. Retrieved 29 May 2015.
↑ 6.06.1Paul, C; Zénut, M; Dorut, A; Coudoré, MA; Vein, J; Cardot, JM; Balayssac, D (February 2015). "Use of domperidone as a galactagogue drug: a systematic review of the benefit-risk ratio". Journal of human lactation : official journal of International Lactation Consultant Association. 31 (1): 57–63. doi:10.1177/0890334414561265. PMID25475074.
↑Leelakanok, N; Holcombe, A; Schweizer, ML (February 2016). "Domperidone and Risk of Ventricular Arrhythmia and Cardiac Death: A Systematic Review and Meta-analysis". Clinical drug investigation. 36 (2): 97–107. doi:10.1007/s40261-015-0360-0. PMID26649742.
↑Stevens JE, Jones KL, Rayner CK, Horowitz M (June 2013). "Pathophysiology and pharmacotherapy of gastroparesis: current and future perspectives". Expert Opinion on Pharmacotherapy. 14 (9): 1171–86. doi:10.1517/14656566.2013.795948. PMID23663133. S2CID23526883.
↑Silvers D, Kipnes M, Broadstone V, Patterson D, Quigley EM, McCallum R, Leidy NK, Farup C, Liu Y, Joslyn A (1998). "Domperidone in the management of symptoms of diabetic gastroparesis: efficacy, tolerability, and quality-of-life outcomes in a multicenter controlled trial. DOM-USA-5 Study Group". Clinical Therapeutics. 20 (3): 438–53. doi:10.1016/S0149-2918(98)80054-4. PMID9663360.
↑Janssen P, Harris MS, Jones M, Masaoka T, Farré R, Törnblom H, Van Oudenhove L, Simrén M, Tack J (September 2013). "The relation between symptom improvement and gastric emptying in the treatment of diabetic and idiopathic gastroparesis". The American Journal of Gastroenterology. 108 (9): 1382–91. doi:10.1038/ajg.2013.118. PMID24005344. S2CID32835351.
↑Lertxundi, U; Domingo-Echaburu, S; Soraluce, A; García, M; Ruiz-Osante, B; Aguirre, C (February 2013). "Domperidone in Parkinson's disease: a perilous arrhythmogenic or the gold standard?". Current drug safety. 8 (1): 63–8. doi:10.2174/1574886311308010009. PMID23656449.
↑Donovan TJ, Buchanan K (2012). "Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants". The Cochrane Database of Systematic Reviews. 3 (3): CD005544. doi:10.1002/14651858.CD005544.pub2. PMID22419310.
↑Leelakanok N, Holcombe A, Schweizer ML (2015). "Domperidone and Risk of Ventricular Arrhythmia and Cardiac Death: A Systematic Review and Meta-analysis". Clin Drug Investig. 36 (2): 97–107. doi:10.1007/s40261-015-0360-0. PMID26649742. S2CID25601738.
↑van Noord C, Dieleman JP, van Herpen G, Verhamme K, Sturkenboom MC (November 2010). "Domperidone and ventricular arrhythmia or sudden cardiac death: a population-based case-control study in the Netherlands". Drug Safety. 33 (11): 1003–14. doi:10.2165/11536840-000000000-00000. PMID20925438. S2CID21177240.
↑Johannes CB, Varas-Lorenzo C, McQuay LJ, Midkiff KD, Fife D (September 2010). "Risk of serious ventricular arrhythmia and sudden cardiac death in a cohort of users of domperidone: a nested case-control study". Pharmacoepidemiology and Drug Safety. 19 (9): 881–8. doi:10.1002/pds.2016. PMID20652862.
↑ 39.039.1Buffery PJ, Strother RM (2015). "Domperidone safety: a mini-review of the science of QT prolongation and clinical implications of recent global regulatory recommendations". N. Z. Med. J. 128 (1416): 66–74. PMID26117678.
↑Djeddi D, Kongolo G, Lefaix C, Mounard J, Léké A (November 2008). "Effect of domperidone on QT interval in neonates". The Journal of Pediatrics. 153 (5): 663–6. doi:10.1016/j.jpeds.2008.05.013. PMID18589449.
↑Sakamoto Y, Kato S, Sekino Y, Sakai E, Uchiyama T, Iida H, Hosono K, Endo H, Fujita K, Koide T, Takahashi H, Yoneda M, Tokoro C, Goto A, Abe Y, Kobayashi N, Kubota K, Maeda S, Nakajima A, Inamori M (2011). "Effects of domperidone on gastric emptying: a crossover study using a continuous real-time 13C breath test (BreathID system)". Hepato-gastroenterology. 58 (106): 637–41. PMID21661445.
↑Parkman HP, Jacobs MR, Mishra A, Hurdle JA, Sachdeva P, Gaughan JP, Krynetskiy E (January 2011). "Domperidone treatment for gastroparesis: demographic and pharmacogenetic characterization of clinical efficacy and side-effects". Digestive Diseases and Sciences. 56 (1): 115–24. doi:10.1007/s10620-010-1472-2. PMID21063774. S2CID39632855.
↑ 51.051.151.251.351.451.5Brouwers JR, Assies J, Wiersinga WM, Huizing G, Tytgat GN (1980). "Plasma prolactin levels after acute and subchronic oral administration of domperidone and of metoclopramide: a cross-over study in healthy volunteers". Clin. Endocrinol. 12 (5): 435–40. doi:10.1111/j.1365-2265.1980.tb02733.x. PMID7428183.
↑Hospital Formulary. HFM Publishing Corporation. 1991. p. 171. Archived from the original on 28 October 2020. Retrieved 22 September 2016. Domperidone, a benzimidazole derivative, is structurally related to the butyrophenone tranquilizers (eg, haloperidol (Haldol, Halperon]).
↑ 60.060.160.2Sneader, Walter (2005). "Plant Product Analogues and Compounds Derived from Them". Drug discovery : a history. Chichester: John Wiley & Sons Ltd. p. 125. ISBN978-0-471-89979-2.
↑Corsini, Giovanni Umberto (2010). "Apomorphine: from experimental tool to therpeutic aid". In Ban, Thomas A; Healy, David; Shorter, Edward (eds.). The Triumph of Psychopharacology and the Story of CINP. CINP. p. 54. ISBN978-9634081814. {{cite book}}: |archive-url= requires |url= (help); Unknown parameter |chapterurl= ignored (help); Unknown parameter |lastauthoramp= ignored (help)
↑"Domperidone". Pharmaceutical Manufacturing Encyclopedia, 3rd Edition (Vol. 1-4). William Andrew Publishing. 2013. p. 138. ISBN9780815518563. Archived from the original on 5 June 2015. Retrieved 12 December 2014.
↑"Domperidone". Archived from the original on 1 December 2017. Retrieved 3 January 2017.
↑Reddymasu SC, Soykan I, McCallum RW (2007). "Domperidone: review of pharmacology and clinical applications in gastroenterology". Am. J. Gastroenterol. 102 (9): 2036–45. PMID17488253.
↑Hofmeyr, G. J.; Van Iddekinge, B.; Van Der Walt, L. A. (2009). "Effect of domperidone-induced hyperprolactinaemia on the menstrual cycle; a placebo-controlled study". Journal of Obstetrics and Gynaecology. 5 (4): 263–264. doi:10.3109/01443618509067772. ISSN0144-3615.