Motilium (Domperidone)

Domperidone acts as a prokinetic and antiemetic, targeting disorders of gastrointestinal motility and nausea pathways.

• Nausea: reduces the sensation of nausea and the urge to vomit.
• Vomiting: helps control acute and chronic vomiting episodes.
• Gastroparesis: accelerates gastric emptying and improves stomach emptying in delayed gastric motility.
• Functional dyspepsia: alleviates upper abdominal discomfort and fullness associated with dyspepsia.

• Domperidone selectively blocks peripheral dopamine D2 receptors, which removes inhibitory control on gastrointestinal smooth muscle. This action enhances gastric motility, speeds gastric emptying, and increases lower esophageal sphincter tone, thereby reducing reflux and facilitating the passage of contents through the digestive tract.

Domperidone may cause a range of adverse reactions, from mild to serious.

Common Side Effects

• Dry mouth: reduced salivary flow causing throat discomfort.
• Abdominal cramps: intermittent stomach pain or discomfort.
• Headache: mild to moderate head pain.
• Dizziness: sensation of light‑headedness or imbalance.
• Constipation: reduced bowel movements.
• Increased prolactin: mild breast tenderness or galactorrhea.

Serious or Rare Side Effects

• Cardiac arrhythmia: irregular heart rhythm, potentially life‑threatening.
• QT interval prolongation: risk of torsades de pointes.
• Severe allergic reaction: rash, swelling, or anaphylaxis.
• Neuroleptic malignant syndrome: rare but serious muscle rigidity and fever.
• Extrapyramidal symptoms: involuntary muscle movements.
• Hepatotoxicity: abnormal liver function tests.

Before prescribing Domperidone, clinicians should consider several safety measures.

• Cardiac assessment: evaluate history of arrhythmia or QT prolongation.
• Electrolyte monitoring: correct hypokalemia, hypomagnesemia, or hypocalcemia.
• Hepatic function: adjust use in patients with liver impairment.
• Drug interactions: avoid concomitant use with strong CYP3A4 inhibitors.
• Pregnancy and lactation: use only if potential benefit outweighs risk.
• Store at ambient temperature: keep in the original pack, protect from moisture.

Domperidone can interact with several medicines, requiring careful management.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin): may increase domperidone plasma levels and cardiac risk.
• QT‑prolonging agents (e.g., quinidine, erythromycin, haloperidol): additive risk of arrhythmia.
• Anticholinergic drugs: may exacerbate gastrointestinal side effects.

Moderate Interactions (Monitor Closely)

• Other antiemetics (e.g., metoclopramide): overlapping dopaminergic effects.
• Antipsychotics (e.g., risperidone): potential additive prolactin elevation.
• Drugs metabolized by CYP3A4 (e.g., statins, calcium channel blockers): monitor for altered concentrations.