A fixed-dose combination (FDC) of a prokinetic antiemetic (Domperidone) and a proton pump inhibitor (Pantoprazole). Domperidone enhances gastric motility and acts as an antiemetic by peripheral dopamine D2 receptor antagonism. Pantoprazole provides potent and long-lasting inhibition of gastric acid secretion by irreversibly blocking the H+/K+ ATPase enzyme system (proton pump) of the gastric parietal cell. This combination is primarily used for the symptomatic relief of upper gastrointestinal disorders where both acid suppression and prokinetic/antiemetic effects are desired, such as gastroesophageal reflux disease (GERD) with associated nausea and delayed gastric emptying.
Adult: One tablet (Domperidone 10mg + Pantoprazole 20mg) once or twice daily, 15-30 minutes before a meal. Maximum: 2 tablets per day (i.e., Domperidone 20mg + Pantoprazole 40mg). Duration should be as short as possible, not exceeding 1 week for domperidone component.
Note: Swallow the tablet whole with a glass of water, do not crush, chew, or break. Take 15-30 minutes before food, preferably before breakfast and/or dinner. The enteric coating ensures pantoprazole is released in the intestine.
Domperidone acts as a selective peripheral dopamine D2 and D3 receptor antagonist. It blocks dopamine receptors in the chemoreceptor trigger zone (CTZ) and the gastric wall. Blockade in the CTZ produces an antiemetic effect. Blockade in the upper GI tract increases lower esophageal sphincter pressure, enhances gastric peristalsis and antral contractions, and improves gastroduodenal coordination, thereby accelerating gastric emptying. Pantoprazole is a substituted benzimidazole that accumulates in the acidic compartment of the parietal cell, where it is protonated and rearranges into its active form (sulfenamide). This active form covalently binds to cysteine residues on the luminal surface of the H+/K+ ATPase (proton pump), irreversibly inhibiting the final step of gastric acid secretion.
Pregnancy: Category B (US FDA) for Pantoprazole. Domperidone: Data limited. Use only if clearly needed and potential benefit outweighs risk. Avoid in first trimester unless absolutely necessary.
Driving: May cause dizziness, fatigue, or visual disturbances. Patients should not drive or operate machinery if they experience these effects.
| Ketoconazole, Itraconazole, Fluconazole, Voriconazole | Potent CYP3A4 inhibitors increase domperidone plasma levels, significantly increasing risk of QT prolongation and cardiac arrhythmias. | Contraindicated / Major |
| Clarithromycin, Erythromycin, Telithromycin | CYP3A4 inhibitors and also prolong QT interval. Synergistic risk of serious ventricular arrhythmias. | Contraindicated / Major |
| Atazanavir, Ritonavir, Nelfinavir (HIV Protease Inhibitors) | CYP3A4 inhibitors. Increase domperidone levels and cardiac risk. | Major |
| Amiodarone, Quinidine, Procainamide, Sotalol | Concurrent use with domperidone increases additive risk of QT prolongation. | Major |
| Warfarin | Pantoprazole may inhibit CYP2C19, potentially increasing INR and risk of bleeding. Monitor INR closely. | Moderate |
| Diazepam, Phenytoin | Pantoprazole may inhibit their metabolism (CYP2C19), increasing their levels and effects. | Moderate |
| Methotrexate (especially high-dose) | PPIs like pantoprazole may decrease renal clearance of methotrexate, increasing toxicity risk. | Moderate |
| Digoxin | Domperidone may increase gastric emptying, potentially reducing digoxin absorption if taken simultaneously. | Moderate |
| Antacids | May interfere with absorption of pantoprazole. Administer antacids at least 2 hours apart. | Minor |
| Clopidogrel | Pantoprazole, a moderate CYP2C19 inhibitor, may reduce the antiplatelet efficacy of clopidogrel (a prodrug activated by CYP2C19). Consider alternative PPI (like pantoprazole is often preferred over omeprazole, but caution is still advised). | Moderate |
Same composition (Domperidone (10mg) + Pantoprazole (20mg)), different brands: