📋 Clinical Overview

Domperidone is a dopamine D2 and D3 receptor antagonist with antiemetic and prokinetic properties. It acts as a potent peripheral dopamine antagonist, blocking dopamine receptors in the chemoreceptor trigger zone (CTZ) and the upper gastrointestinal tract. Unlike metoclopramide, it does not readily cross the blood-brain barrier, significantly reducing the risk of extrapyramidal side effects. It is widely used in the Indian market for the management of nausea, vomiting, and functional dyspepsia.

💊 Dosage & Administration

Adult: Oral: 10-20 mg (1-2 ml of 10mg/ml suspension) three to four times daily, preferably 15-30 minutes before meals and at bedtime. Maximum daily dose: 30 mg (3 ml) in patients <60 kg or with mild renal impairment; 40 mg (4 ml) in patients >60 kg with normal renal/hepatic function.

Note: Shake the oral suspension well before use. Use the measuring cup or oral syringe provided for accurate dosing. Administer 15-30 minutes before meals and at bedtime for optimal prokinetic effect. For nausea/vomiting alone, can be taken as needed. Do not exceed the prescribed dose or duration.

⚠️ Contraindications

Known hypersensitivity to domperidone or any excipient.
Conditions where cardiac conduction is or could be impaired, especially QT interval prolongation (congenital or acquired).
Significant electrolyte disturbances (hypokalemia, hypomagnesemia).
Moderate or severe hepatic impairment (Child-Pugh B or C).
Concomitant use with potent CYP3A4 inhibitors (e.g., ketoconazole, fluconazole, clarithromycin, ritonavir).
Prolactin-releasing pituitary tumor (prolactinoma).
Gastrointestinal hemorrhage, mechanical obstruction, or perforation.

🔬 Mechanism of Action

Domperidone competitively blocks peripheral dopamine D2 and D3 receptors located in the chemoreceptor trigger zone (CTZ) outside the blood-brain barrier and in the upper gastrointestinal tract. This blockade inhibits the nausea/vomiting reflex triggered by dopamine. In the GI tract, it increases lower esophageal sphincter pressure, enhances gastroduodenal peristalsis and coordination, and accelerates gastric emptying, without stimulating gastric acid secretion.

🤕 Side Effects

Headache
Dry mouth
Diarrhea
Abdominal cramps
Dizziness
Skin rash or itching
Increased serum prolactin levels leading to galactorrhea, breast enlargement/tenderness, menstrual irregularities

🤰 Special Populations

Pregnancy: Category C (US FDA). Animal studies have shown adverse effects. No adequate, well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus, especially in the first trimester. Not recommended for routine use.

Driving: Domperidone may cause dizziness, somnolence, or blurred vision in some patients. Patients should not drive or operate machinery if they experience these effects.

🔄 Drug Interactions

Ketoconazole, Fluconazole, Itraconazole, Voriconazole	Potent CYP3A4 inhibitors. Dramatically increase domperidone plasma levels, leading to high risk of QT prolongation and arrhythmias.	Contraindicated
Clarithromycin, Erythromycin, Telithromycin	Potent CYP3A4 inhibitors and also prolong QT. Concomitant use is contraindicated.	Contraindicated
Protease Inhibitors (Ritonavir, Saquinavir)	Potent CYP3A4 inhibitors. Contraindicated.	Contraindicated
Amiodarone, Dronedarone, Quinidine, Sotalol	Other QT-prolonging drugs. Additive risk of life-threatening arrhythmias. Avoid combination.	Major
Anticholinergics (e.g., Atropine, Hyoscine)	May antagonize the gastrointestinal prokinetic effects of domperidone.	Moderate
Dopamine Agonists (e.g., Bromocriptine, Levodopa)	Domperidone may antagonize the therapeutic effect of these drugs in Parkinson's disease.	Moderate
Warfarin	Theoretical interaction due to protein binding displacement; monitor INR.	Minor

🔁 Alternatives to Dompan Suspension

Same composition (Domperidone (10mg/ml)), different brands:

Domstal Suspension Vomistop Suspension Perinorm Suspension Domperon Suspension