Motilium (Domperidone Maleate)

• Motilium (domperidone) is used to manage conditions related to impaired gastrointestinal motility.
• Nausea and vomiting: Reduces episodes by accelerating gastric emptying.
• Gastroparesis: Improves stomach emptying and symptom relief in diabetic or idiopathic gastroparesis.
• Functional dyspepsia: Alleviates post‑prandial fullness and upper abdominal discomfort.

• Domperidone acts peripherally as a dopamine D2 receptor antagonist. By blocking D2 receptors in the chemoreceptor trigger zone and gastrointestinal smooth muscle, it removes inhibitory dopaminergic tone, thereby increasing acetylcholine release, enhancing gastric contractility and accelerating gastric emptying without crossing the blood‑brain barrier. The selective peripheral action limits central nervous system effects.

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

Common Side Effects

• Dry mouth: reduced salivation.
• Abdominal cramps: mild gastrointestinal discomfort.
• Headache: transient head pain.
• Dizziness: light‑headed sensation.
• Constipation: decreased bowel movements.

Serious or Rare Side Effects

• Cardiac arrhythmia (QT prolongation): potentially life‑threatening rhythm disturbances.
• Severe allergic reaction: rash, swelling, or anaphylaxis.
• Extrapyramidal symptoms: involuntary muscle movements or tremor.
• Hyperprolactinemia: elevated prolactin leading to galactorrhea.

When prescribing domperidone, clinicians should consider several safety precautions.

• Cardiac assessment: evaluate risk of QT prolongation, especially in patients with cardiac disease.
• Concomitant medications: avoid use with strong CYP3A4 inhibitors that may increase plasma levels.
• Electrolyte monitoring: correct hypokalemia or hypomagnesemia that predispose to arrhythmias.
• Hepatic function: use with caution in patients with liver impairment; dose adjustment may be needed.
• Pregnancy and lactation: assess benefit‑risk before use; limited data available.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Domperidone interacts with several medicines that can alter its safety or effectiveness.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin): may raise domperidone levels and increase cardiac risk.
• QT‑prolonging drugs (e.g., erythromycin, quinidine, sotalol): additive effect on cardiac repolarization.
• Antifungal agents (e.g., fluconazole) that inhibit metabolism: elevate systemic exposure.

Moderate Interactions (Monitor Closely)

• Antacids containing aluminum or magnesium: may reduce domperidone absorption; separate administration by at least 2 hours.
• Other dopamine antagonists (e.g., metoclopramide): may enhance dopaminergic blockade and side‑effect profile.
• Certain antidepressants (e.g., SSRIs): monitor for additive QT effects.