Understanding and Using Domperidone: A Patient's Guide

When it comes to managing certain digestive issues, medications like Domperidone can play a crucial role. In this guide, we will break down the information found in the Patient Information Leaflet (PIL) for Domperidone, making it more accessible for individuals without a medical background.

What is Domperidone?

Domperidone is a medication that falls under the class of benzimidazole derivatives. It possesses both prokinetic (promotes movement) and antiemetic (prevents nausea and vomiting) properties. Essentially, Domperidone works as a dopaminergic antagonist, influencing various aspects of the digestive system.

How Does Domperidone Work?

Understanding how Domperidone works is essential to grasp its benefits. It acts by increasing the pressure in the lower esophageal sphincter, inhibiting relaxation of the gastric fundus, enhancing antral (stomach) contractility, and relaxing the pyloric sphincter. These actions collectively help in managing conditions related to delayed gastric emptying, gastroesophageal reflux, and esophagitis.

Indications for Use

Domperidone is prescribed for the short-term treatment of nausea and vomiting caused by various factors, including functional issues, infections, organic disorders, or those induced by radiotherapy or drug therapy. It is also indicated for gastrointestinal disorders associated with delayed gastric emptying, gastroesophageal reflux, and esophagitis.

Possible Side Effects

Like any medication, Domperidone may cause side effects. Some individuals may experience increased plasma prolactin concentrations, potentially leading to galactorrhea (breast milk production) or gynecomastia (enlarged breasts in males). Reduced libido, central effects such as dystonic reactions or drowsiness, and occasional rashes are also reported side effects.

When Not to Use Domperidone

Domperidone is contraindicated in individuals with known hypersensitivity to the drug or when stimulation of gastric motility may be dangerous, such as in cases of gastrointestinal bleeding, obstruction, or perforation. It is also contraindicated in individuals with prolactin-releasing pituitary tumors (prolactinomas).

Drug Interactions and Precautions

It's crucial to be aware of potential drug interactions. Opioid analgesics and antimuscarinics may counteract the prokinetic effects of Domperidone. Additionally, Domperidone may counteract the hypoprolactinemic effect of drugs like Bromocriptine.

Patients with renal insufficiency should have a reduced dose frequency. In Parkinsonian patients being treated for nausea and vomiting, therapy may continue for a maximum of 12 weeks. When using antacids or antisecretory agents concurrently, they should be taken after meals, not simultaneously with Domperidone.

Use During Pregnancy and Lactation

While animal studies show no teratogenic effects at doses up to 160mg/kg/day, the safety of Domperidone during human pregnancy and lactation has not been definitively established. It should be used during the first trimester of pregnancy only if justified by the anticipated therapeutic benefit. Nursing is not recommended unless the expected benefits outweigh potential risks.

Dosage Recommendations

Dosage varies based on the formulation:

Tablets:

• For nausea and vomiting: 2 tablets 3-4 times daily.
• For gastrointestinal disorders: 1 tablet 3 times daily (preferably 15-30 minutes before meals), and if necessary, 1 tablet before bedtime. Dosage can be doubled when required.

Oral Suspension:

• Adults: 10-20 ml, 3-4 times daily before meals and before bedtime (based on severity).
• Children: 2.5 - 5 ml/10 kg body weight, 3-4 times daily before meals and before bedtime (based on severity).

Suppositories:

• Adults: 30-60mg every 4-8 hours.
• Children:
  • Up to 2 years: 1 suppository (10 mg) 2-4 times daily.
  • 2-4 years: 1 suppository (30 mg) twice daily.
  • 4-6 years: 1 suppository (30 mg) 3 times daily.
  • Over 6 years: 1 suppository (30 mg) 4 times daily.

Storage and Presentation

Domperidone should be kept at temperatures not exceeding 30°C, while suppositories should be stored at temperatures not exceeding 15°C. It's important to keep the medication out of reach of children. Domperidone is typically available in boxes containing 20 or 1000 tablets, bottles of 120ml suspension, and boxes of 6 suppositories in various strengths (10mg, 30mg, or 60mg).

Conclusion

In conclusion, Domperidone is a medication with valuable prokinetic and antiemetic properties, making it effective for managing nausea, vomiting, and certain gastrointestinal disorders. However, like any medication, it's essential to use it under proper medical guidance, considering contraindications, potential side effects, and appropriate dosage. Always consult with your healthcare provider for personalized advice and to address any concerns regarding Domperidone.