Motilium, known generically as domperidone, is a dopamine antagonist specifically indicated for the management of upper gastrointestinal motility disorders. It functions by enhancing the peristaltic movements of the stomach and duodenum, increasing lower esophageal sphincter tone, and acting as an antiemetic. This medication is a cornerstone in gastroenterological therapeutics for patients suffering from symptoms like nausea, vomiting, bloating, and early satiety associated with delayed gastric emptying. Its mechanism of action, primarily through peripheral dopamine D2 and D3 receptor blockade, makes it a valuable agent where prokinetic and antiemetic effects are required without significant central nervous system penetration. Prescribed under medical supervision, it addresses underlying dysmotility rather than merely masking symptoms.

Features

• Active ingredient: Domperidone 10 mg per tablet
• Pharmacological class: Dopamine D2 and D3 receptor antagonist
• Formulation: Oral tablets, dispersible tablets, and suspension
• Onset of action: Typically within 30–60 minutes post-administration
• Half-life: Approximately 7–9 hours in adults
• Metabolism: Hepatic, primarily via CYP3A4
• Excretion: Renal and fecal

Benefits

• Effectively reduces symptoms of nausea and vomiting by blocking dopamine receptors in the chemoreceptor trigger zone
• Enhances gastric emptying and improves gastroduodenal coordination, alleviating postprandial fullness and bloating
• Increases lower esophageal sphincter pressure, reducing gastroesophageal reflux symptoms
• Minimal penetration of the blood-brain barrier, lowering the risk of extrapyramidal side effects compared to central dopamine antagonists
• Available in multiple formulations to suit patient-specific needs, including pediatric suspensions
• Supports improved nutritional intake and quality of life in chronic motility disorder patients

Common use

Motilium is primarily indicated for the symptomatic treatment of nausea and vomiting of functional origin, and for the relief of dyspeptic symptoms such as postprandial fullness, epigastric discomfort, bloating, and belching associated with delayed gastric emptying. It is also used off-label in some jurisdictions to stimulate lactation, though this is not a universally approved indication. Commonly prescribed for gastroparesis (diabetic or idiopathic), chronic nausea, and as an adjunct in the management of gastroesophageal reflux disease (GERD) where prokinetic activity is beneficial.

Dosage and direction

Adults and adolescents (12 years and older, weighing 35 kg or more):
The usual dose is 10 mg to 20 mg (one to two tablets) taken three to four times daily, preferably 15–30 minutes before meals and at bedtime. The maximum daily dose should not exceed 80 mg (8 tablets).

Children:
Dosing is weight-based: 0.25–0.5 mg/kg per dose, administered three to four times daily, up to a maximum of 2.4 mg/kg/day, not to exceed 80 mg daily. Use only under strict medical supervision and with age-appropriate formulations.

Administration:
Tablets should be swallowed whole with water. Dispersible tablets may be dissolved in water for ease of administration. Take on an empty stomach for optimal absorption and effect. Treatment duration should be the shortest necessary to control symptoms; long-term use requires periodic reevaluation.

Precautions

• Use with caution in patients with hepatic impairment; dose adjustment may be necessary.
• Electrolyte disturbances (e.g., hypokalemia, hypomagnesemia) should be corrected prior to and during therapy.
• Not recommended for long-term use without regular clinical assessment due to potential cardiac risks.
• Avoid in elderly patients, except when clearly necessary and under close monitoring.
• Use during pregnancy only if potential benefits justify potential risks; avoid during lactation unless specifically indicated and monitored.
• May mask underlying malignant conditions; ensure proper diagnostic evaluation before initiating symptomatic treatment.

Contraindications

• Known hypersensitivity to domperidone or any excipient in the formulation.
• Conditions where gastrointestinal stimulation might be dangerous, such as gastrointestinal hemorrhage, mechanical obstruction, or perforation.
• Prolactinoma or known prolactin-releasing pituitary tumor.
• Moderate to severe hepatic impairment.
• Co-administration with potent CYP3A4 inhibitors (e.g., ketoconazole, erythromycin).
• Pre-existing cardiac conditions such as congestive heart failure, or history of ventricular arrhythmia.
• Significant electrolyte abnormalities.

Possible side effect

Common side effects (≥1/100 to <1/10):

• Dry mouth
• Headache
• Abdominal cramps
• Diarrhea
• Rash or itching

Uncommon side effects (≥1/1,000 to <1/100):

• Drowsiness or fatigue
• Agitation or nervousness
• Galactorrhea, gynecomastia, or menstrual irregularities due to hyperprolactinemia

Rare but serious side effects (<1/1,000):

• QT prolongation and associated ventricular arrhythmias, including torsades de pointes
• Sudden cardiac death (in patients with risk factors or high doses)
• Neurologic effects such as extrapyramidal symptoms (rare due to peripheral action)
• Severe hypersensitivity reactions

Drug interaction

• CYP3A4 inhibitors (e.g., ketoconazole, fluconazole, clarithromycin, ritonavir): Significantly increase domperidone plasma levels; contraindicated.
• Other QT-prolonging drugs (e.g., antipsychotics, antiarrhythmics, certain antibiotics): Additive risk of arrhythmias; avoid combination.
• Anticholinergic agents: May antagonize the prokinetic effects of domperidone.
• Dopaminergic agonists (e.g., levodopa, bromocriptine): Domperidone may reduce their efficacy.
• Antacids and H2-receptor antagonists: May reduce oral absorption of domperidone; administer separately.

Missed dose

If a dose is missed, take it as soon as remembered, unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed one. Resume the regular dosing schedule. Consistent timing relative to meals is important for optimal therapeutic effect.

Overdose

Symptoms may include agitation, confusion, seizures, somnolence, and extrapyramidal reactions. Cardiac manifestations such as QT prolongation, arrhythmias, and cardiac arrest are possible. There is no specific antidote. Management includes immediate discontinuation, gastric lavage if recent ingestion, activated charcoal, and supportive care with ECG monitoring. Treatment of arrhythmias may require magnesium sulfate or other antiarrhythmics. Seek emergency medical attention.

Storage

Store below 30°C (86°F), in a dry place, protected from light and moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging. For dispersible tablets and suspension, follow specific storage instructions provided with the product.

Disclaimer

This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting, changing, or stopping any medication. Do not disregard professional medical advice or delay seeking it based on content provided here. The manufacturer and publisher are not liable for any outcome resulting from the use or misuse of this information.

Reviews

Clinical studies and meta-analyses have demonstrated domperidone’s efficacy in reducing symptoms of gastroparesis and functional dyspepsia, with significant improvement in gastric emptying times and patient-reported outcomes. However, its use is tempered by cardiovascular safety concerns, particularly at higher doses or in susceptible populations. It remains a valuable tool in gastroenterology when used appropriately under medical supervision.