Domperidone Parkinson disease

Domperidone is a dopamine antagonist that acts on the chemoreceptor trigger zone. It can therefore be used as an anti-emetic in nausea and vomiting, for example, to counteract side-effects of cytotoxic therapy and to treat nausea associated with dopaminergic drugs used in Parkinson s disease. Unlike hyoscine butlybromide and antihistamines, domperidone is ineffective in motion sickness. 

Apomorphine is a potent dopamine agonist, which is sometimes useful in advanced Parkinson s disease for patients with severe unpredictable off periods on treatment. It is only available as a subcutaneous injection or infusion and thus requires significant patient and/or carer involvement in treatment. It is highly emetogenic so patients must receive domperidone, starting at least 2 days before apomorphine treatment. 

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). 

Soykan I, Sarosiek I, Shifflett J, Wooten GF, McCallum RW. Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with Parkinson s disease. Mov Disord 1997 12(6) 952-7. 

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. 

Josamycin. An elderly man with Parkinson s disease, well-controlled for 10 months with daily levodopa/benserazide, bromocriptine 70 mg and domperidone, was additionally given josamycin 2 g daily for a respiratory infection. Shortly after the first dose he became drowsy with visual hallucinations, and began to show involuntary movements of his limbs, similar... 

Domperidone is a dopamine antagonist similar to metoclopramide. However, since it acts on the dopamine receptors in the stomach wall, and unlike metoclopramide, it does not readily cross the blood-brain barrier, it does not appear to oppose the effects of levodopa within the brain, although some extrapyramidal symptoms have been observed. It may even slightly increase the bioavailability and effects of levodopa (by stimulating gastric emptying). Domperidone can therefore be used to control the nausea and vomiting associated with levodopa treatment of Parkinson s disease. 

Rios Romenets S, DauviUiers Y, Cochen De Cock V, Carlander B, Bayard S, Galatas C, et al. Restless legs syndrome outside the blood-brain barrier-exacerbation by domperidone in Parkinson s disease. Park Relat Disord 2013 19 92-4. 

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