Domperidone
A peripherally acting dopamine D2 antagonist for short-term relief of nausea and vomiting; it can prolong the QT interval.
Drug card
- How it works
- Blocking dopamine D2 receptors in the trigger zone and the gut
- Used for
- Short-term relief of nausea and vomiting
- Known for
- QT prolongation and torsades de pointes
- Raised prolactin: breast milk leakage, missed periods
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does domperidone work?
Blocks D2 receptors in the gut wall and in the chemoreceptor trigger zone, a site the blood-brain barrier does not shield, so it eases nausea and speeds gastric emptying. Little enters the brain, which makes extrapyramidal effects very rare, but it still raises prolactin from the pituitary. CYP3A4 breaks it down, so CYP3A4 inhibitors raise its levels.
Like other dopamine antagonist antiemetics: These drugs block dopamine D2 receptors in the gut wall and in the chemoreceptor trigger zone, a brainstem site the blood-brain barrier does not shield. The gut effect raises lower esophageal sphincter tone and speeds gastric emptying, so they are prokinetic as well as antiemetic, and both raise prolactin. Metoclopramide also acts in the brain and can cause movement disorders; domperidone barely gets in.
Uses
What is domperidone used for?
- Short-term relief of nausea and vomiting
Side effects
Side effects of domperidone
- QT prolongation and torsades de pointesKnown forSerious
- Raised prolactin: breast milk leakage, missed periodsKnown for
- Ventricular arrhythmias and sudden cardiac deathSerious
- Dry mouth
- Breast enlargement in men (gynecomastia)
- Drowsiness
- Headache
- Diarrhea
- Movement disorders (rare)
- SeizuresSerious
- Urinary retention
- Anaphylaxis and angioedemaSerious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated with QT-prolonging drugs, potent CYP3A4 inhibitors, heart disease, QT prolongation or electrolyte imbalance.
- Contraindicated in moderate or severe liver impairment and with a prolactin-secreting pituitary tumor.
- Cardiac risk is higher over age 60 and at higher daily doses: use the lowest dose, usually for no more than a week.
- Antacids and acid-reducing drugs lower its absorption, so they are given after meals and domperidone before.
Good to know: Not approved in the US. After a 2014 review of its heart risks, the EU kept it only for nausea and vomiting, at lower doses and for about a week.
Remember it
A way to remember it
Domperidone stays outside the brain; metoclopramide moves in.
Both block D2 receptors in the trigger zone, which sits outside the blood-brain barrier. Domperidone hardly crosses the barrier, so movement disorders are very rare with it, while metoclopramide does cross and can cause dystonia and tardive dyskinesia.
Written for biofideX
Its class
Dopamine antagonist antiemetics
Other dopamine antagonist antiemetics with a card:
Easily mixed up with 5-HT3 antagonists and first-generation antipsychotics.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Domperidone-containing medicines: referral (EMA)
- Domperidone 1mg/ml oral suspension: SmPC (eMC)
- About domperidone (NHS)
- Side effects of domperidone (NHS)
- Domperidone (NCI Thesaurus)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Stomach and gut
Domperidone is one of 15 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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