Domperidone is an antiemetic (anti-sickness) and prokinetic drug. It belongs to a group of drugs called dopamine antagonists. It is used to treat stomach-related issues, such as nausea and vomiting, as well as stomach pain and discomfort caused by decreased movement of the stomach and upper gastrointestinal (GI) tract. It is also used to boost breastmilk supply.

Domperidone works by blocking dopamine receptors in the gut. It increases the movement or contractions of the muscles in your stomach and intestines, increasing how quickly and easily food moves through your digestive tract. It also acts on the chemoreceptor trigger zone in your brain, which is involved in nausea and vomiting. This area of your brain is outside the blood-brain barrier. Unlike other dopamine antagonists, domperidone does not cross the blood-brain barrier, which minimizes central nervous system (CNS) side effects.

Domperidone works to boost breastmilk supply by increasing the level of a hormone called prolactin, which stimulates the production of breastmilk.

Domperidone is available on prescription and in some places as an over-the-counter (OTC) medicine. It is available in many places around the world, including the UK, Europe, Canada and New Zealand. Approved uses of the drug vary from country to country. It is also used for off-label or unapproved conditions, including boosting breastmilk supply. Domperidone is not approved for use in the US, but some patients with severe gastrointestinal motility disorders can still access it through an expanded access investigation new drug (IND) application.

Domperidone first became available in the late 1970s.

What is domperidone used for?

Domperidone is used for a range of conditions including:

• To treat nausea (feeling sick) and vomiting (being sick), including when it is caused by migraine headaches
• To prevent nausea and vomiting caused by certain medicines used to treat Parkinson's disease, including levodopa and pergolide
• To relieve discomfort caused by a slow moving stomach known as gastroparesis. Symptoms include indigestion (dyspepsia), not being able to finish a meal, feeling too full or bloated after a meal, a loss of appetite, feeling sick and maybe vomiting, or belching without relief
• To increase breastmilk supply

Domperidone may cause an increased risk of heart rhythm disorder and cardiac arrest. This risk may be more likely in those over 60 years old or taking doses higher than 30 mg per day. The risk also increases when it is given together with some drugs. Tell your doctor or pharmacist if you are taking drugs to treat infection (fungal infections or bacterial infection) and/or if you have heart problems or AIDS/HIV.

Domperidone should be used at the lowest effective dose in adults and adolescents 12 years of age and older and a body weight of 35kg or more.

While taking this medicine, contact your doctor if you experience heart rhythm disorders such as palpitations, trouble breathing, loss of consciousness. Treatment with domperidone should be stopped.

• Always take this medicine exactly as your doctor or pharmacist tells you to. You should check with them if you are not sure.
• Your doctor will decide how long you will need to take this medicine. Gastric symptoms usually resolve within 3-4 days of using this medicine. Do not take for more than 7 days without talking to your doctor.
• Oral forms of domperidone - oral tablet, oral suspension, oral drops and orally disintegrating tablet
  • Take this medicine by mouth.
  • It is recommended to take oral domperidone 15 to 30 minutes before meals, as when taken after meals the absorption of the medicine is slightly delayed.
  • Swallow the tablets whole with a drink of water. Do not crush or chew them.
  • Orally disintegrating tablets (orodispersible tablets) dissolve in the mouth and do not need to be taken with water.
  • If taking the oral suspension, use the plastic measuring cup that comes with it.
  • If taking the oral drops, use the dropper that comes with it.
• Suppositories containing domperidone
  • To insert a suppository into your rectum (back passage) take the following steps:
    • First wash your hands.
    • The suppository should be moistened and then inserted into the bottom as far as possible.
    • Once this has been done tense your muscles to prevent the suppository coming out.
  • Food and drink does not affect the absorption of domperidone suppositories.

Adults and adolescents 12 years of age and older and with a body weight of 35 kg or more:

• Tablet. The usual dose is one 10mg tablet taken up to three times per day, if possible before meals. It is usually recommended not to take more than three tablets (30 mg) per day, but in some cases your doctor may recommend taking up to 4 tablets (40 mg) per day.
• Oral suspension. The usual dose is 10 ml taken up to three times per day, if possible before meals. Do not take more than 30 ml per day.
• Suppositories. The usual dose is one 30 mg suppository two times a day. Do not use more than two suppositories per day.

See full prescribing information for more details about domperidone dosing.

Do not take domperidone tablets if:

• You are allergic to domperidone or any of the other ingredients in it. Signs of an allergic reaction include:
  • Rash
  • Swallowing or breathing problems
  • Swelling of your lips, face, throat or tongue
• You have a tumor of the pituitary gland (prolactinoma)
• You have a blockage or tear in your intestines
• You have black, tarry bowel motions (stools) or notice blood in your bowel motions. This could be a sign of bleeding in the stomach or intestines.
• You have a moderate or severe liver disease
• Your ECG (electrocardiogram) shows a heart problem called “prolonged QT corrected interval”
• You have or had a problem where your heart cannot pump the blood round your body as well as it should (condition called heart failure)
• You have a problem that gives you a low level of potassium or magnesium, or a high level of potassium in your blood
• You are taking certain medicines (see Interactions below)

Do not take domperidone if any of the above applies to you. If you are not sure, talk to your doctor or pharmacist before taking this medicine.

What should I tell my doctor before taking domperidone?

Before you take domperidone, tell your healthcare provider about all of your medical conditions, including if you:

• You suffer from liver problems (liver function impairment or failure)
• You suffer from kidney problems (kidney function impairment or failure). It is advisable to ask your doctor for advice in case of prolonged treatment as you may need to take a lower dose or take this medicine less often, and your doctor may want to examine you regularly.

If you miss a dose of domperidone, take it as soon as you remember. However if it is almost time for the next dose, wait until that is due and then continue as normal. Do not take a double dose to make up for a missed dose.

If you take too much domperidone, seek medical attention straight away. In the event of overdose, symptomatic treatment can be implemented. An ECG monitoring may be undertaken, because of the possibility of a heart problem called prolonged QT interval.

The signs of taking more than you should include feeling sleepy, confused, uncontrolled movements which include unusual eye movements, unusual movements of the tongue or abnormal posture (such as a twisted neck).