Oroperidys (Domperidone)

• Domperidone acts on the dopaminergic pathways that regulate gastrointestinal motility and the vomiting centre.
• Nausea and vomiting: reduces symptoms associated with medication, chemotherapy or postoperative states.
• Gastroparesis: enhances gastric emptying in patients with delayed stomach emptying.
• Functional dyspepsia: alleviates upper abdominal discomfort and bloating.

• Domperidone selectively blocks peripheral D2 dopamine receptors in the chemoreceptor trigger zone and the gastrointestinal tract, which reduces nausea signalling and increases the tone of the lower oesophageal sphincter. By antagonising dopamine in the gut wall, it promotes acetylcholine release, enhancing gastric motility and accelerating gastric emptying without crossing the blood‑brain barrier in significant amounts.

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

Common Side Effects

• Dry mouth: reduced salivary flow causing throat discomfort.
• Headache: mild to moderate pain often transient.
• Abdominal cramps: discomfort in the stomach area.
• Dizziness: sensation of light‑headedness.
• Diarrhoea: loose stools occurring shortly after dosing.
• Constipation: reduced bowel movements.

Serious or Rare Side Effects

• Cardiac arrhythmia (QT prolongation): may lead to palpitations or fainting.
• Severe allergic reaction: rash, swelling, or difficulty breathing.
• Extrapyramidal symptoms: rare movement disorders such as tremor.
• Hyperprolactinaemia: elevated prolactin causing galactorrhoea.
• Hepatic dysfunction: abnormal liver enzymes.
• Neuroleptic malignant syndrome: extremely rare, characterised by fever and muscle rigidity.

• Before prescribing Domperidone, clinicians should evaluate patient‑specific risk factors and monitor for adverse events.
• Assess cardiac risk: review history of arrhythmia or prolonged QT interval.
• Monitor QT interval: obtain baseline ECG in high‑risk patients.
• Avoid in hepatic impairment: dose adjustment may be required.
• Use caution in the elderly: increased susceptibility to side effects.
• Review concomitant QT‑prolonging drugs: consider alternatives or enhanced monitoring.
• Store at room temperature: keep in the original pack, protect from moisture.

Domperidone can interact with several medicines, altering its safety profile or efficacy.

Major Interactions (Avoid)

• Ketoconazole: potent CYP3A4 inhibition increases domperidone levels.
• Erythromycin or clarithromycin: raise plasma concentrations, heightening cardiac risk.
• Other QT‑prolonging agents (e.g., quinidine, sotalol): additive effect on cardiac repolarisation.
• Cisapride: combined dopamine antagonism may cause severe arrhythmias.

Moderate Interactions (Monitor Closely)

• Fluconazole: moderate CYP3A4 inhibition may require ECG monitoring.
• Anticholinergic drugs: may blunt pro‑kinetic effect.
• Antacids containing aluminium or magnesium: can reduce domperidone absorption if taken simultaneously.