Motilium (Domperidone)

Motilium is used to manage conditions affecting gastrointestinal motility and emesis.

• Nausea and vomiting: reduces episodes by enhancing gastric emptying and blocking peripheral dopamine receptors.
• Gastroparesis: improves gastric motility and alleviates associated symptoms such as early satiety and bloating.
• Functional dyspepsia: lessens upper abdominal discomfort and improves meal tolerance.

• Domperidone acts peripherally by antagonizing dopamine D2 receptors in the chemoreceptor trigger zone and gastrointestinal smooth muscle. This blockade increases the release of acetylcholine, enhancing gastric emptying and intestinal transit, while also reducing the emetic signal transmitted to the brain, resulting in anti‑emetic and pro‑kinetic effects.

Domperidone may cause a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Dry mouth: reduced salivation leading to throat discomfort.
• Abdominal cramps: intermittent stomach pain.
• Headache: mild to moderate intensity.
• Dizziness: sensation of light‑headedness.
• Constipation or diarrhea: altered bowel habits.
• Fatigue: feeling unusually tired.

Serious or Rare Side Effects

• Cardiac arrhythmia (QT prolongation): may lead to irregular heartbeat.
• Severe allergic reactions: rash, swelling, or anaphylaxis.
• Extrapyramidal symptoms: rare movement disorders.
• Hyperprolactinemia: elevated prolactin causing galactorrhea.
• Hepatic dysfunction: abnormal liver enzymes.
• Sudden cardiac death: extremely rare but reported in high‑dose or high‑risk patients.

Before prescribing Domperidone, clinicians should evaluate patient‑specific risk factors and follow safe handling practices.

• Cardiac risk assessment: review ECG and QT interval in patients with known heart disease.
• Concomitant CYP3A4 inhibitors: avoid or adjust therapy when strong inhibitors are used.
• Hepatic impairment: use with caution and consider dose reduction.
• Duration of therapy: limit to the shortest effective period to reduce adverse events.
• Electrolyte monitoring: check potassium and magnesium in patients on diuretics or with renal disease.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Domperidone interacts with several drug classes that can modify its safety or efficacy.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): increase domperidone plasma concentrations and risk of cardiac toxicity.
• QT‑prolonging agents (e.g., quinidine, sotalol): additive effect on cardiac repolarisation, raising arrhythmia risk.

Moderate Interactions (Monitor Closely):\n- Anticholinergic drugs: may exacerbate dry‑mouth side effect.

• Other anti‑emetics (e.g., metoclopramide): overlapping mechanisms could increase adverse neurologic effects.
• Electrolyte‑altering diuretics: may potentiate cardiac risk when combined with domperidone.