Domperidone adverse effects

Domperidone minimally crosses the BBB it acts in the CTZ which lies outside of the BBB. As such, domperidone is less likely to cause the centrally-mediated adverse effects seen with metoclopramide and has an estimated overall incidence of 5% to 10%.1,30 However, domperidone has been associated with prolonged QT intervals, cardiac arrhythmias, and sudden death.31 It should not be used for patients with underlying long QT interval or for those on other medications that prolong the QT interval. Both metoclopramide and domperidone can cause hyperprolactinemia, galactorrhea, and gynecomastia. 

Adverse effects of cisapride in causing cardiac dysrhythmias have led to withdrawal from general use. Metoclopramide and domperidone are well described as occasionally causing dyskinesias, particularly in younger people. Treatment is generally licensed for short term typically six week prescription. 

Domperidone is sometimes recommended to promote postpartum lactation (see also Adverse Effects). 

Domperidone may be the antiemetic of choice in this patient. Despite being extensively metabolised by the liver it has few adverse effects and does not cross the blood-brain barrier. 

Domperidone may be the antiemetic of choice in this patient. Despite being extensively metabolised by the Hver it has few adverse effects and does not cross the blood-brain barrier. The bioavailability is hkely to be increased as first-pass metabolism will be reduced because of portal hypertension. There may also be accumulation of domperidone owing to reduced metabolic capacity. Consequently the dose should be reduced to 50% and titrated up to 10 mg three times a day if necessary. 

Nausea and vomiting are the commonest adverse effects these may respond to domperidone but tend to become less marked as treatment continues. Postural hypotension may cause dizziness or syncope. In high dose confusion, delusions or hallucinations may occur and, after prolonged use, pleural effusion and retroperitoneal fibrosis. 

Domperidone is a neuroleptic antiemetic, a dopamine receptor antagonist. It produces the expected range of dystonic and extrapyramidal adverse effects (1), which seem, as with metoclopramide, to be more likely to occur in children (2). It is difficult to accept that claims for lower frequencies than with metoclopramide are justified, particularly when one reads a report of neuroleptic malignant sjmdrome (3). Like its congeners, domperidone has repeatedly been shown to cause sjmptoms attributable to hyperprolactinemia (galactorrhea, amenorrhea, and breast tenderness), despite claims that there is a lower incidence of effects on prolactin concentrations. However, a study in patients with Parkinson s disease using domperidone did not suggest that the adverse effects are especially problematical in these patients (4). 

The mechanism of action and chnical use of domperidone and its specific use in diabetic gastroparesis have been reviewed (5,6). Domperidone is generally well tolerated and has a low incidence of adverse effects. Adverse effects after oral administration include headache, dry mouth, diarrhea, itching, muscle cramps, and anxiety. Galactorrhea, breast tenderness, and pseudopregnancy can occur in women because of a dopamine-induced increase in serum prolactin concentration. 

The efficacy and adverse effects of domperidone and metoclopramide have been compared in a double-bhnd, multicenter, randomized trial in 93 insuhn-dependent diabetics with symptomatic gastroparesis (7). Domperidone 20 mg qds and metoclopramide 10 mg qds, for 4 weeks, were equally effective in alleviating sjmptoms of gastroparesis. Somnolence, akathisia, anxiety, and depression were more... 

Thirty randomized, controlled trials from 1975 to 1996 were analyzed to quantify the antiemetic efficacy and adverse effects of cannabis when given to 1366 patients receiving chemotherapy. Oral nabUone, oral dronabinol, and intramuscular levonantradol were compared with conventional antiemetics (prochlorperazine, metoclopramide, chlor-promazine, thiethylperazine, haloperidol, domperidone, and aliza-pride) or placebo. Across all trials, cannabinoids were slightly more effective than active comparators and placebo when the chemotherapy regimen was of moderate emetogenic potential, and patients preferred them. No dose-response relationships were evident to the authors. The cannabinoids were also more toxic side effects included euphoria, drowsiness, sedation, somnolence, dysphoria, depression, hallucinations, and paranoia. The efficacy of cannabinoids as compared to SSRls has not been studied. Use of these agents should be considered when other regimens do not provide desired efficacy. 

The hypotensive adverse effects of apomorphine may possibly be increased by alcohol. The concurrent use of other drugs used for erectile dysfunction or dopamine agonists or antagonists is not recommended. However, domperidone, and prochlorperazine are said not to interact when apomorphine is used for erectile dysfunction, and domperidone is the recommended antiemetic when apomorphine is used for Parkinson s disease. There is evidence that antidepressants, antiepileptics, and ondansetron do not interact adversely. 

Note that prochlorperazine should not be given if apomorphine is used for Parkinson s disease, as its dopamine antagonist actions can worsen the disease (see also Levodopa + Antiemetics , p.682). Because apomorphine is highly emetogenic at the doses required for the treatment of Parkinson s disease (1 to 4 mg/hour by subcutaneous infusion), patients with Parkinson s disease requiring apomorphine should be pretreated with domperidone 20 mg three times daily for at least 2 days. Rare reports of extrapyramidal adverse effects have been reported with ondansetron, which may be of relevance in patients with Parkinson s Disease. 

Perez Blanco JL, Garcia Angleu F, Caceres Espejo J, Panadero Ruz Ma D. Extrapyramidal effects as a possible adverse reaction to domperidone. Rev Esp Pediatr 2000 56 189-92. 

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