domperidone (Motilium)

use of domperidone is associated with increased risk of serious ventricular arrythmias and sudden cardiac death, particularly in adults aged greater than 60 years taking daily doses greater than 30mg
initiate Rx at the lowest effective dose
avoid in those taking medications which may increase plasma levels of domperidone such as agents which inhibit CYP3A4 including ketoconazole, erythroycin, diltaizem, verapamil, and many antivirals
avoid in those at risk of prolonged QTc
patients should stop using it if they develop dizziness, palpitations, syncope or seizures

introduction

a pro-kinetic anti-emetic, dopamine antagonist acting mainly on the D2 and D3 dopamine receptors which are found in the chemoreceptor trigger zone
it does not cross the BBB
a gastrointestinal motility modifier indicated for the short term Rx of:
- symptoms associated with idiopathic or diabetic gastroparesis in adults (eg. due to autonomic neuropathy)
- intractable nausea and vomiting
it has also been used off-label to promote lactation as it results in increased prolactin secretion, despite warnings that it is transmitted to the neonate in the breast milk, and babies appear to be at increased risk of seizures and prolonged QTc when the mother is taking oral doses