Motilium (Domperidone)

Domperidone acts as a peripheral dopamine antagonist to improve gastrointestinal motility and reduce nausea.

• Nausea and vomiting: reduces episodes of nausea and vomiting associated with various causes.
• Gastroparesis: enhances gastric emptying and alleviates related symptoms such as early satiety.
• Functional dyspepsia: relieves upper abdominal discomfort and improves digestive comfort.

• Domperidone selectively blocks peripheral dopamine D2 receptors in the gastrointestinal tract and the chemoreceptor trigger zone. By antagonising dopamine, it increases the release of acetylcholine, which stimulates smooth‑muscle contractions, thereby accelerating gastric emptying and reducing the neural signals that trigger nausea and vomiting.

Domperidone is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Dry mouth: reduced salivation leading to a feeling of thirst.
• Abdominal cramps: mild to moderate stomach discomfort.
• Headache: transient pain in the head region.
• Dizziness: sensation of light‑headedness or unsteadiness.
• Diarrhoea: loose stools occurring intermittently.
• Constipation: reduced bowel movements.

Serious or Rare Side Effects

• Cardiac arrhythmia (QT prolongation): may cause irregular heart rhythm.
• Severe allergic reaction: rash, swelling, or difficulty breathing.
• Extrapyramidal symptoms: involuntary muscle movements.
• Neuroleptic malignant syndrome: rare but life‑threatening condition.
• Hyperprolactinemia: elevated prolactin levels causing hormonal effects.
• Hepatic dysfunction: abnormal liver enzyme elevations.

Before prescribing Domperidone, clinicians should consider several safety aspects.

• Cardiac risk assessment: evaluate history of arrhythmia or electrolyte imbalance.
• Liver function monitoring: adjust use in patients with hepatic impairment.
• Concomitant QT‑prolonging drugs: avoid or monitor closely.
• CYP3A4 inhibitors: use caution with strong inhibitors that raise domperidone levels.
• Pediatric use: restrict to children only when clearly indicated and prescribed.
• Store at ambient temperature: keep in the original pack, protect from moisture.

Domperidone may interact with other medicines, requiring attention to avoid adverse outcomes.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): may increase domperidone plasma concentrations.
• QT‑prolonging agents (e.g., quinidine, haloperidol): additive risk of cardiac arrhythmia.
• Antifungal azoles (e.g., itraconazole): elevate domperidone levels.
• HIV protease inhibitors (e.g., ritonavir): potentiate exposure.
• Certain macrolide antibiotics (e.g., clarithromycin): raise risk of toxicity.

Moderate Interactions (Monitor Closely)

• Anticholinergic drugs: may blunt prokinetic effect.
• Other prokinetics (e.g., metoclopramide): overlapping mechanisms.
• Drugs metabolised by CYP3A4 (e.g., midazolam): possible altered levels.
• Diuretics: monitor electrolytes that influence cardiac risk.
• NSAIDs: watch for gastrointestinal irritation.