domperidone

REMS

Symptoms associated with GI motility disorders, including subacute/chronic gastritis and diabetic gastroparesis.
Nausea/vomiting associated with dopamine agonist antiparkinson therapy.

Unlabeled Use:

To stimulate lactation.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity/intolerance;
Concurrent use of ketoconazole;
Prolactinoma;
Conditions where GI stimulation is dangerous, including GI hemorrhage/mechanical obstruction/perforation;
Lactation: Lactation.

Use Cautiously in:

History of breast cancer;
Severe renal impairment (dose adjustment may be necessary during chronic therapy);
Hepatic impairment;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal harm;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: hot flashes, rash

GI: dry mouth

GU: amenorrhea, impotence

Endo: galactorrhea, gynecomastia, hyperprolactinemia

Neuro: headache, insomnia

Interactions ⬆ ⬇

Drug-drug:

Ketoconazole may ↑ levels and risk of cardiovascular toxicity; concurrent use contraindicated; other azole antifungals, macrolide anti-infectives, and protease inhibitors may have similar effects.
QT interval prolonging medications may ↑ risk of QT interval prolongation.
Effectiveness may be ↓ by anticholingeric medications.
Due to effects on gastric motility, absorption of drugs from the small intestine may be accelerated, while absorption of drugs from the stomach may be slowed, especially sustained-release or enteric-coated formulations.

Drug-Food:

Grapefruit juice may ↑ levels and risk of toxicity.

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

Upper Gastrointestinal Motility Disorders

PO (Adults ): 10 mg 3 times daily (max = 30 mg/day).

Renal Impairment

PO (Adults ): Depending on degree of impairment, dosing during chronic therapy should be ↓ to once or twice daily.

Nausea/Vomiting Due to Dopamine Agonists

PO (Adults ): 10 mg 3 times daily; higher doses may be required during dose titration (max = 30 mg/day).

Renal Impairment

PO (Adults ): Depending on degree of impairment, dosing during chronic therapy should be ↓ to once or twice daily.

Action ⬆ ⬇

Acts as a peripheral dopamine receptor blocker.
↑GI motility, peristalsis, and ↓ esophageal sphincter pressure.
Facilitates gastric emptying and ↓ small bowel transit time.
↑prolactin levels.

Therapeutic effects:

Improved GI motility.
Decreased nausea/vomiting associated with dopamine agonist antiparkinson therapy.

Classifications ⬆ ⬇

Therapeutic Classification: gastric stimulant

Pharmacologic Classification: butyrophenones, dopamine antagonists

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration.

Distribution: Does not cross the blood-brain barrier.

Protein Binding: 93%.

Metabolism/Excretion: Undergoes extensive first-pass hepatic metabolism, much via the CYP3A4 isoenzyme. 31% excreted in urine; 66% excreted in feces.

Half-Life: 7 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	30 min	6–8 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Advise to take as directed.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Advise patient to avoid grapefruit juice during therapy.
Advise patient to notify health care provider if galactorrhea (excessive or spontaneous flow of breast milk), gynecomastia (excessive development of male mammary gland), menstrual irregularities (spotting or delayed periods), palpitations, irregular heartbeat (arrhythmia), dizziness, or fainting occur.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇