A new precaution recommending vigilance for signs or symptoms of cardiac arrhythmia was recently introduced for Motilium® (domperidone).
Prolongation of the QT interval may be exacerbated by taking higher doses, and other medicines that prolong the QT interval, or slow the elimination of domperidone by inhibiting the cytochrome P450 isoenzyme CYP3A4. Fluconazole, ketoconazole, voriconazole, clarithromycin, erythromycin, amiodarone, and telithromycin may do both.
Domperidone should be used with caution in patients with underlying cardiovascular risk factors, and should not be used in patients with moderate to severe hepatic impairment.
The TGA are now considering further restrictions to the dosage guidelines, in line with new limits recommended to The European Medicine Agency of less than 30mg daily for no more than one week. Domperidone is no longer marketed in the United States.
Domperidone is a useful antiemetic, related to metoclopramide, which does not readily cross the blood-brain barrier or cause extra-pyramidal side effects.
Please review full product information before prescribing.