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Domperidone
General information
Domperidone is a neuroleptic antiemetic, a dopamine receptor antagonist. It produces the expected range of dystonic and extrapyramidal adverse effects [ ], which seem, as with metoclopramide, to be more likely to occur in children [ ]. It is difficult to accept that claims for lower frequencies than with metoclopramide are justified, particularly when one reads a report of neuroleptic malignant syndrome [ ]. Like its congeners, domperidone has repeatedly been shown to cause symptoms 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 [ ].
Drug studies
Observational studies
The mechanism of action and clinical use of domperidone and its specific use in diabetic gastroparesis have been reviewed [ , ]. 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.
Comparative studies
The efficacy and adverse effects of domperidone and metoclopramide have been compared in a double-blind, multi-center, randomized trial in 93 insulin-dependent diabetics with symptomatic gastroparesis [ ]. Domperidone 20 mg qds and metoclopramide 10 mg qds, for 4 weeks, were equally effective in alleviating symptoms of gastroparesis. Somnolence, akathisia, anxiety, and depression were more severe with metoclopramide. Of the spontaneously reported adverse effects, nausea, vomiting, headache, insomnia, and diarrhea occurred in 6–10% of patients treated with domperidone and in up to 4% of patients treated with metoclopramide. The incidence of prolactin-related adverse effects was similar in the two groups (6%).
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