Motilium (Domperidone)

Domperidone is a gastroprokinetic that acts on peripheral dopamine receptors to improve gastric motility.

• Nausea and vomiting: reduces episodes by enhancing gastric emptying and providing antiemetic effect.
• Gastroparesis: improves stomach emptying, alleviating symptoms such as early satiety and bloating.
• Functional dyspepsia: relieves upper abdominal discomfort by promoting gastrointestinal transit.

• Domperidone selectively blocks peripheral dopamine D2 receptors in the gastrointestinal tract and the chemoreceptor trigger zone. This antagonism removes dopamine‑mediated inhibition of gastrointestinal smooth‑muscle activity, thereby increasing motility, accelerating gastric emptying, and exerting an antiemetic effect without significant central nervous system penetration.

Domperidone may be associated with several adverse reactions, ranging from mild to serious.

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.
• Diarrhoea: loose stools.
• Constipation: reduced bowel movements.

Serious or Rare Side Effects

• Cardiac arrhythmia (QT prolongation): risk of torsades de pointes.
• Severe allergic reaction: rash, swelling, or anaphylaxis.
• Extrapyramidal symptoms: involuntary muscle movements.
• Hyperprolactinaemia: elevated prolactin causing galactorrhoea.
• Neuroleptic malignant syndrome: rare but life‑threatening condition.

When prescribing domperidone, clinicians should consider several safety measures.

• Assess cardiac risk: evaluate QT interval in patients with known cardiac disease.
• Avoid in patients with known arrhythmias: risk of exacerbating QT prolongation.
• Use caution in hepatic impairment: reduced clearance may increase exposure.
• Monitor for endocrine effects: watch for galactorrhoea or menstrual disturbances.
• Avoid concomitant use with strong CYP3A4 inhibitors: may raise plasma levels.
• Store at ambient temperature: keep in the original pack, protect from moisture and light.

Domperidone interacts with several drug classes; awareness helps prevent adverse events.

Major Interactions (Avoid)

• CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, clarithromycin): can markedly increase domperidone concentrations and heighten cardiac risk.
• Antifungal azoles: similar effect on metabolism leading to toxicity.

Moderate Interactions (Monitor Closely)

• Anticholinergic agents: may diminish the pro‑kinetic effect of domperidone.
• Other antiemetics (e.g., metoclopramide): additive effects on gastrointestinal motility.
• SSRIs or other QT‑prolonging drugs: combined use may increase the likelihood of cardiac arrhythmias.