Gastrointestinal
Domperidone
A prokinetic anti-sickness drug — Eases nausea and helps the stomach empty — now used short-term because of heart-rhythm cautions.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
Quick answer
What is Domperidone?
Domperidone treats nausea and vomiting and helps a sluggish stomach empty. It is chosen where avoiding the movement side-effects of other anti-sickness drugs matters, but is now used short-term because of heart-rhythm cautions.
- How it works: It blocks dopamine receptors in the gut and the part of the brain that triggers vomiting, settling nausea and encouraging the stomach to empty.
- In practice: In practice domperidone relieves nausea and vomiting and helps the stomach empty (it is "prokinetic"), and it has the practical advantage that it does not readily cross into the brain, so it causes fewer of the movement side-effects seen with some other anti-sickness drugs.
What it is
Domperidone treats nausea and vomiting and helps a sluggish stomach empty. It is chosen where avoiding the movement side-effects of other anti-sickness drugs matters, but is now used short-term because of heart-rhythm cautions.
How it works
It blocks dopamine receptors in the gut and the part of the brain that triggers vomiting, settling nausea and encouraging the stomach to empty. Because it largely stays out of the main brain, it causes fewer movement side-effects — but its effect on the heart's electrical system is why it carries QT cautions.
In practice
In practice domperidone relieves nausea and vomiting and helps the stomach empty (it is "prokinetic"), and it has the practical advantage that it does not readily cross into the brain, so it causes fewer of the movement side-effects seen with some other anti-sickness drugs. However, regulators restricted its use after evidence that it can prolong the QT interval and rarely cause serious heart-rhythm problems, so it is now used at the lowest effective dose for the shortest time, and avoided in people with significant heart disease, certain electrolyte disturbances, moderate-to-severe liver impairment and alongside other QT-prolonging or interacting drugs. Within those limits it remains useful — for example for nausea where movement side-effects must be avoided, and in some reflux or gastroparesis situations under guidance. It is generally not used long-term without good reason and review.
Examples
Practical use
How to take it & use it well
- Take it before meals, as it tends to work better when taken a short while before food rather than after.
- Use it at the lowest amount that controls your symptoms and for the shortest time needed, because longer or higher use raises the risk of heart-rhythm problems.
- Tell your doctor about any heart conditions, fainting, or family history of sudden heart problems before starting, as it is not suitable for everyone.
- If you miss a dose, take it when you remember unless it is nearly time for the next one, then skip it. Do not double up.
- Stop and seek medical advice if you develop palpitations, fainting or an irregular heartbeat while taking it.
- Do not take it for longer than advised without a review, and check with a pharmacist before combining it with other medicines.
Common uses
- Nausea and vomiting (short-term)
- Slow stomach emptying (gastroparesis) and some reflux, under guidance
- Where movement side-effects of other antiemetics must be avoided
Monitoring
- Symptom response and shortest effective duration
- Cardiac risk factors, electrolytes and QT where relevant
- Interacting medicines before prescribing
Weighing it up
Advantages & disadvantages
Advantages
- It helps relieve nausea and vomiting and can ease symptoms linked to slow stomach emptying.
- It causes fewer movement-related side effects than some alternatives such as metoclopramide, because it acts mainly outside the brain.
- It can be useful when feeling sick is making it hard to keep food or other medicines down.
- It is taken by mouth and fits easily into a daily routine before meals.
- Short-term use under guidance is effective for many people.
Disadvantages
- It can affect the heart's electrical rhythm, which is why it is limited to low amounts for short periods.
- It is not suitable for people with certain heart conditions, electrolyte imbalances, or significant liver problems.
- It interacts with several common medicines that also affect heart rhythm or how it is broken down.
- It should not be used long term without review because of the cumulative heart risk.
- It may not be appropriate for older or frail people who are more vulnerable to rhythm problems.
Key safety principles
What to watch for
- Can prolong the QT interval and rarely cause serious arrhythmias — use the lowest effective dose for the shortest time.
- Avoid in significant heart disease, certain electrolyte problems, moderate-to-severe liver impairment, and with other QT-prolonging or interacting drugs.
- Not generally for long-term use without clear reason and review.
Key interactions
What to avoid or check alongside
- Combining it with other medicines that prolong the heart's QT interval increases the risk of dangerous rhythm disturbances.
- Certain macrolide antibiotics and azole antifungals can raise its levels in the body and add to the heart risk.
- Low potassium or magnesium, sometimes caused by water tablets, increases the chance of rhythm problems while taking it.
- Other medicines processed by the same liver pathway can increase its concentration and side effects.
- It should be used cautiously alongside other treatments for nausea to avoid overlapping effects.
Patient & carer advice
- Use it for as short a time as possible
- Tell us about heart problems or other medicines before taking it
- Report palpitations, fainting or an irregular heartbeat
Use with
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Answers
Domperidone: frequently asked questions
Why is domperidone only recommended for short-term use?
It can affect the heart's electrical rhythm, and this risk is greater with higher amounts and longer use. To keep it safe, it is used at the lowest effective amount for the shortest time needed.
Who should avoid domperidone?
People with certain heart conditions, an irregular heartbeat, significant liver problems, or low potassium or magnesium should generally avoid it. Always tell your doctor about your medical history before starting.
How is domperidone different from metoclopramide?
Domperidone acts mainly outside the brain, so it causes fewer movement-related side effects than metoclopramide. However, it carries more concern about heart rhythm, so each is chosen based on your situation.
When is the best time to take domperidone?
It is usually taken a short while before meals, as this can help it work more effectively for nausea and stomach symptoms. Follow the specific timing advised for you.
Can I take domperidone with antibiotics?
Some antibiotics, particularly certain macrolides, can interact with domperidone and increase heart-rhythm risk. Always check with your pharmacist or doctor before combining it with any new medicine.
Authoritative sources
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