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Dyspepsia - unidentified cause - Management
What issues should I consider before prescribing domperidone?
- Domperidone is licensed for the relief of the symptoms of nausea and vomiting, epigastric sense of fullness, upper abdominal discomfort and regurgitation of gastric contents. This indication is licensed for use in adults and in children aged over 12 years of age, weighing 35 kg or more.
- Domperidone is also available over the counter, licensed for the relief of post-prandial symptoms of fullness, nausea, epigastric bloating and belching that is occasionally accompanied by epigastric discomfort and heartburn. Maximum duration of course of treatment 2 weeks. It is licensed for use in those aged 16 and above.
- Contraindications:
- Avoid using domperidone in those where stimulation of the gastric motility could be harmful e.g. gastrointestinal haemorrhage, mechanical obstruction or perforation.
- Avoid in those with prolactin-releasing pituitary tumour (prolactinoma).
- Since domperidone is highly metabolized in the liver, it should be not be used in those with hepatic impairment.
- Dose:
- For adults and adolescents (over 12 years and weighing 35 kg or more): 10 mg to 20 mg; to be taken three to four times per day. Maximum daily dose: 80 mg.
- For those with severe renal impairment, the dose may need to be reduced.
- The initial duration of treatment is four weeks. Patients should be re-evaluated after four weeks and the need for continued treatment re-assessed.
- Domperidone should be taken 15 to 30 minutes before meals. If taken after meals, absorption of the drug is delayed.
- Drug interaction:
- The manufacturer advises avoiding the concomitant use of domperidone and ketoconazole (a slight increase of the QT interval has been reported).
- Adverse effects:
- Domperidone is generally very well tolerated with few undesirable effects.
- It may cause an increase in prolactin levels. In rare cases, this hyperprolactinaemia may lead to neuro-endocrinological side effects such as galactorrhoea, gynaecomastia and amenorrhoea.
- Extrapyramidal side effects are very rare as domperidone does not readily cross the blood-brain barrier. These side effects reverse spontaneously and completely as soon as the treatment is stopped.
[ABPI Medicines Compendium, 2004; ABPI Medicines Compendium, 2007]
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