Prokinetic, peripheral dopamine D2 receptor antagonist
ATC code: A03FA03 (Domperidone)
A peripheral dopamine D2 receptor antagonist in the GI tract and chemoreceptor trigger zone. Increases gastric and pyloric contraction amplitude and speeds gastric and small bowel emptying. Unlike metoclopramide, poorly crosses the blood-brain barrier – fewer central side effects (extrapyramidal disorders, sedation). However, causes hyperprolactinemia via hypothalamic action (outside the BBB). In 2014 restricted use due to QT prolongation and ventricular arrhythmia risk.
Second line
Second-line for nausea and vomiting per 2014 after restriction. Dose 10 mg up to 3 times daily for max 1 week. First-line: 5-HT3 antagonists (ondansetron), with or as needed. Before start and with concomitant QT-prolonging drugs, assess cardiovascular risk.
Only in adults and adolescents over 12 weighing over 35 kg (per 2014).
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Off-label use of domperidone as a galactagogue (10–20 mg three times daily) is widespread in breastfeeding forums. Evidence is weak (Asztalos 2017 meta-analysis showed modest milk volume effect without improving feeding outcomes), and maternal QT-prolongation and arrhythmia risk plus potential milk excretion make this use problematic. in 2004 issued a warning against lactation use. In Spain and other EU countries galactagogue is not a registered indication; for insufficient lactation, first-line is latch optimization and lactation-consultant support.
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Limited data. Use in pregnancy not recommended without clear indication.
Passes into milk. FDA in 2004 warned against lactation use as a galactagogue due to maternal QT-prolongation risk and unknown infant effects.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Domperidone is evaluated for the following indications with varying evidence strength: Postoperative nausea and vomiting (evidence tier B), Gastrointestinal smooth muscle spasm (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Domperidone (≥ 1 in 100): Dry mouth, Headache, Drowsiness, Hyperprolactinemia (galactorrhea, amenorrhea, gynecomastia). See the Safety section for uncommon and serious reactions.
FDA category C. Limited data. Use in pregnancy not recommended without clear indication.
Passes into milk. FDA in 2004 warned against lactation use as a galactagogue due to maternal QT-prolongation risk and unknown infant effects.
Domperidone is contraindicated in: Domperidone hypersensitivity; QT prolongation, congenital long QT syndrome; Electrolyte abnormalities (hypokalemia, hypomagnesemia); Concomitant QT-prolonging drugs; Concomitant strong CYP3A4 inhibitors. Full list in the Safety section.