Motilium (Domperidone Maleate)

Motilium acts on peripheral dopamine receptors to manage disorders of gastrointestinal motility and emesis.

• Nausea and vomiting: reduces the frequency and severity of episodes in acute and chronic settings.
• Gastroparesis: enhances gastric emptying and alleviates related symptoms.
• Functional dyspepsia: improves upper abdominal discomfort and post‑prandial fullness.

• Domperidone exerts its effect by selectively antagonising peripheral dopamine D2 receptors located in the chemoreceptor trigger zone and the gastrointestinal tract. This blockade increases the release of acetylcholine, promoting coordinated smooth‑muscle contractions, thereby accelerating gastric emptying and providing an anti‑emetic effect without significant central nervous system penetration.

Adverse reactions may occur with domperidone therapy and are categorized by frequency and severity.

Common Side Effects

• Dry mouth: reduced salivary secretion.
• Abdominal cramps: mild gastrointestinal discomfort.
• Headache: transient cephalic pain.
• Dizziness: occasional light‑headedness.
• Constipation or diarrhea: altered bowel habits.

Serious or Rare Side Effects

• Cardiac arrhythmia: QT interval prolongation leading to torsades de pointes.
• Severe allergic reactions: rash, angioedema, or anaphylaxis.
• Extrapyramidal symptoms: rare movement disorders.
• Hyperprolactinemia: elevated prolactin levels causing galactorrhea.

Before initiating therapy, clinicians should consider several safety aspects.

• Cardiac monitoring: assess QT interval in patients with known cardiac disease or electrolyte disturbances.
• Electrolyte balance: correct hypokalemia and hypomagnesemia to reduce arrhythmia risk.
• Drug interactions: avoid concomitant use with strong CYP3A4 inhibitors.
• Renal impairment: use with caution in severe renal dysfunction, adjusting dose as needed.
• Pregnancy and lactation: prescribe only when benefits outweigh potential risks.
• Store at ambient temperature: keep below 25°C, protect from moisture and light.

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

Major Interactions (Avoid)

• CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): can markedly increase domperidone plasma levels and cardiac toxicity.
• Antifungal azoles (e.g., fluconazole): similar risk of elevated concentrations.

Moderate Interactions (Monitor Closely):\n- Macrolide antibiotics (e.g., erythromycin): may raise domperidone levels modestly.

• Certain antidepressants (e.g., sertraline): additive potential for QT prolongation.
• Anticholinergic agents: may exacerbate dry mouth and constipation.