Changes

<p><strong>Domperidone</strong> (trade names <strong>Motilium</strong>, <strong>Motillium,</strong> <strong>Motinorm</strong> and <strong>Costi</strong>) is an <font color="#0066cc">antidopaminergic</font> <font color="#0066cc">drug</font>, developed by <font color="#0066cc">Janssen Pharmaceutica</font>, and used orally, <font color="#0066cc">rectally</font> or <font color="#0066cc">intravenously</font>, generally to suppress <font color="#0066cc">nausea</font> and <font color="#0066cc">vomiting</font>. It has also been used to stimulate <font color="#0066cc">lactation</font>.</p><table id="toc" summary="Contents" class="toc"> <tbody> <tr> <td> <div id="toctitle"> <h2>Contents</h2> <span class="toctoggle">[<font color="#0066cc">hide</font>]</span></div> <ul> <li class="toclevel-1"><font color="#0066cc"><span class="tocnumber">1</span> <span class="toctext">Uses</span></font> <ul> <li class="toclevel-2"><font color="#0066cc"><span class="tocnumber">1.1</span> <span class="toctext">Gastrointestinal problems</span></font> </li> <li class="toclevel-2"><font color="#0066cc"><span class="tocnumber">1.2</span> <span class="toctext">Lactation</span></font> </li> </ul> </li> <li class="toclevel-1"><font color="#0066cc"><span class="tocnumber">2</span> <span class="toctext">Controversy</span></font> </li> <li class="toclevel-1"><font color="#0066cc"><span class="tocnumber">3</span> <span class="toctext">Pharmacology</span></font> </li> <li class="toclevel-1"><font color="#0066cc"><span class="tocnumber">4</span> <span class="toctext">See also</span></font> </li> <li class="toclevel-1"><font color="#0066cc"><span class="tocnumber">5</span> <span class="toctext">Brand</span></font> </li> <li class="toclevel-1"><font color="#0066cc"><span class="tocnumber">6</span> <span class="toctext">References</span></font> </li> <li class="toclevel-1"><font color="#0066cc"><span class="tocnumber">7</span> <span class="toctext">External links</span></font> </li> </ul> </td> </tr> </tbody></table> 

<p>There is some evidence that domperidone has <font color="#0066cc">antiemetic</font> activity.<sup id="cite_ref-pmid519355_1-0" class="reference"><font size="2"><font color="#0066cc"><span>[</span>2<span>]</span></font></font></sup> Domperidone is used, together with <font color="#0066cc">metoclopramide</font>, <font color="#0066cc">cyclizine</font>, and <font color="#0066cc">5HT_{<font size="2">3</font>} receptor antagonists</font> (such as <font color="#0066cc">granisetron</font>) in the treatment of nausea and vomiting.</p><p>Domperidone is a first choice anti-emetic in most countries,<sup style="WHITE-SPACE: nowrap" class="noprint Template-Fact" title="This claim needs references to reliable sources from November 2008"><font size="2">[<em><font color="#0066cc">citation needed</font></em>]</font></sup>. However, it is not approved for prescription in the US. Although it has never been officially approved for use in the <font color="#0066cc">United States</font>, domperidone is sometimes purchased from <font color="#0066cc">pharmacies</font> in other countries for this purpose.</p><p>It can be used in patients with <font color="#0066cc">Parkinson's disease</font><sup id="cite_ref-pmid6529536_2-0" class="reference"><font size="2"><font color="#0066cc"><span>[</span>3<span>]</span></font></font></sup> because, unlike <font color="#0066cc">metoclopramide</font><sup id="cite_ref-Rossi_3-0" class="reference"><font size="2"><font color="#0066cc"><span>[</span>4<span>]</span></font></font></sup>, domperidone does not cross the <font color="#0066cc">blood-brain barrier</font>.</p><p>Domperidone has also been found effective in the treatment of <font color="#0066cc">gastroparesis</font>,<sup id="cite_ref-pmid9663360_4-0" class="reference"><font size="2"><font color="#0066cc"><span>[</span>5<span>]</span></font></font></sup> a stomach motility condition, and for <font color="#0066cc">paediatric</font> <font color="#0066cc">Gastroesophageal reflux</font> (infant vomiting).</p>

<p>The hormone <font color="#0066cc">prolactin</font> stimulates lactation in humans, and its release is inhibited by the <font color="#0066cc">dopamine</font> secreted by the <font color="#0066cc">hypothalamus</font>. Domperidone, by acting as an anti-dopaminergic, results in increased <font color="#0066cc">prolactin</font> secretion, and thus promotes lactation.</p><p>Since, according to the American <font color="#0066cc">FDA</font>, domperidone is not approved for enhanced lactation in any country,<sup id="cite_ref-5" class="reference"><font size="2"><font color="#0066cc"><span>[</span>6<span>]</span></font></font></sup> it is sometimes self-prescribed from original research or prescribed &quot;<font color="#0066cc">off-label</font>&quot; for this use in countries around the world.<sup id="cite_ref-fda-warn_6-0" class="reference"><font size="2"><font color="#0066cc"><span>[</span>7<span>]</span></font></font></sup></p><p><font color="#0066cc" size="2"></font></p>

<p>Janssen Pharmaceutical has brought domperidone before the FDA several times in the last two decades, with the most recent effort in the 1990s. Numerous U.S. clinical drug trials have demonstrated its safety and efficacy in dealing with gastroparesis symptoms, but the FDA turned down Janssen's application for domperidone, even though the FDA's division of gastrointestinal drugs had approved domperidone.<sup id="cite_ref-7" class="reference"><font size="2"><font color="#0066cc"><span>[</span>8<span>]</span></font></font></sup></p><p>In June 2004, the United States' main regulation agency, the <font color="#0066cc">Food and Drug Administration</font> (FDA), issued a letter warning women not to take domperidone, citing unknown risks to parents and infants, and warned pharmacies that domestic sale was illegal, and that import shipments from other countries would be searched and seized. Domperidone is excreted in breast milk, and no studies on its effects on breastfeeding infants have been reported in the literature. Individual incidents of problems with the drug include <font color="#0066cc">cardiac arrest</font> and <font color="#0066cc">arrhythmia</font>, complications with other medications, as well as complications with improper intravenous use<sup id="cite_ref-fda-warn_6-1" class="reference"><font size="2"><font color="#0066cc"><span>[</span>7<span>]</span></font></font></sup>. A recent paper suggests there may be increased risk of seizures to neonates of mothers taking oral domperidone<sup id="cite_ref-8" class="reference"><font size="2"><font color="#0066cc"><span>[</span>9<span>]</span></font></font></sup>.</p><p>Some doctors and pharmacists do not fully accept the FDA's reasoning and still favor domperidone's use in increasing milk supply. Such doctors and pharmacists claim the drug is safe in the doses given for this purpose but have no evidential data or studies to base their claim.<sup id="cite_ref-9" class="reference"><font size="2"><font color="#0066cc"><span>[</span>10<span>]</span></font></font></sup> The American Academy of Pediatrics considers domperidone &quot;usually compatible with breastfeeding&quot;.<sup id="cite_ref-10" class="reference"><font size="2"><font color="#0066cc"><span>[</span>11<span>]</span></font></font></sup></p><p>There is a new controversy in Britain regarding lethal levels of sodium found in children who are administered this drug. It is now subject to a medical review following a number of criminal trials where parents were charged with child abuse by salt poisoning based on <font color="#0066cc">hypernatremia</font> in the affected children.<sup id="cite_ref-11" class="reference"><font size="2"><font color="#0066cc"><span>[</span>12<span>]</span></font></font></sup> Recent studies also cite increased QT intervals in neonates taking Domperidone. <sup id="cite_ref-pmid18589449_12-0" class="reference"><font size="2"><font color="#0066cc"><span>[</span>13<span>]</span></font></font></sup>.</p>

<p>Domperidone blocks the action of <font color="#0066cc">dopamine</font>. It has strong affinities for the <font color="#0066cc">D_{<font size="2">2</font>}</font> and <font color="#0066cc">D_{<font size="2">3</font>}</font> <font color="#0066cc">dopamine receptors</font> <sup id="cite_ref-13" class="reference"><font size="2"><font color="#0066cc"><span>[</span>14<span>]</span></font></font></sup>, which are found in the <font color="#0066cc">chemoreceptor trigger zone</font>, located just outside the blood brain barrier, which - among others - regulates nausea and vomiting (area postrema on the floor of the fourth ventricle and rhomboid fossa).</p>

<li><font color="#0066cc">itopride</font> </li> <li><font color="#0066cc">metoclopramide</font> </li> <li><font color="#0066cc">benzamide</font> </li> <li><font color="#0066cc">cisapride</font> </li>

<p>Many brand names and combinations of the drug exist. The combination of domperidone and <font color="#0066cc">pantoprazole</font> is marketed as <font color="#0066cc">Dompan</font> by <font color="#0066cc">Medley Pharmaceuticals</font>. Domperidone is sold as <font color="#0066cc">Motinorm</font> by <font color="#0066cc">GlaxoSmithKline</font>. In India for Paediatric purpose Domperidone is available as Domperi Suspension(Domperidone 1&nbsp;mg/ml, 30 ml Suspension;Ipca Laboratories Ltd, Mumbai)<font color="#0066cc">[1]</font>and Domstal(Torrent Pharmaceuticals Ltd.)<font color="#0066cc">[2]</font></p><p><font color="#0066cc"></font>&nbsp;</p>

<li id="cite_note-0"><strong><a title="" href="#cite_ref-0"><font colorsize="#0066cc+0">^</font></a></strong> <a class="external text" title="http://www.medsafe.govt.nz/downloads/MCC34Domperidone.doc" rel="nofollow" href="http://www.medsafe.govt.nz/downloads/MCC34Domperidone.doc"><font colorsize="#0066cc+0">Domperidone</font></a> MedSafe NZ Government </li> <li id="cite_note-pmid519355-1"><strong><a title="" href="#cite_ref-pmid519355_1-0"><font colorsize="#0066cc+0">^</font></a></strong> <cite style="FONT-STYLE: normal" id="CITEREFSwann_IL.2C_Thompson_EN.2C_Qureshi_K1979">Swann IL, Thompson EN, Qureshi K (November 1979). &quot;<a class="external text" title="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&amp;artid=1597274" rel="nofollow" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&amp;artid=1597274"><font colorsize="#0066cc+0">Domperidone or metoclopramide in preventing chemotherapeutically induced nausea and vomiting</font></a>&quot;. <em>British medical journal</em> <strong>2</strong> (6199): 1188. <a class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/519355" href="http://www.ncbi.nlm.nih.gov/pubmed/519355"><font colorsize="#0066cc+0">PMID 519355</font></a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Domperidone+or+metoclopramide+in+preventing+chemotherapeutically+induced+nausea+and+vomiting&amp;rft.jtitle=British+medical+journal&amp;rft.aulast=Swann+IL%2C+Thompson+EN%2C+Qureshi+K&amp;rft.au=Swann+IL%2C+Thompson+EN%2C+Qureshi+K&amp;rft.date=November+1979&amp;rft.volume=2&amp;rft.issue=6199&amp;rft.pages=1188&amp;rft_id=info:pmid/519355&amp;rfr_id=info:sid/en.wikipedia.org:Domperidone"><span style="DISPLAY: none">&nbsp;</span></span> </li> <li id="cite_note-pmid6529536-2"><strong><a title="" href="#cite_ref-pmid6529536_2-0"><font colorsize="#0066cc+0">^</font></a></strong> <cite style="FONT-STYLE: normal" id="CITEREFShindler_JS.2C_Finnerty_GT.2C_Towlson_K.2C_Dolan_AL.2C_Davies_CL.2C_Parkes_JD1984">Shindler JS, Finnerty GT, Towlson K, Dolan AL, Davies CL, Parkes JD (December 1984). &quot;<a class="external text" title="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&amp;artid=1463696" rel="nofollow" href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&amp;artid=1463696"><font colorsize="#0066cc+0">Domperidone and levodopa in Parkinson's disease</font></a>&quot;. <em>British journal of clinical pharmacology</em> <strong>18</strong> (6): 959&ndash;62. <a class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/6529536" href="http://www.ncbi.nlm.nih.gov/pubmed/6529536"><font colorsize="#0066cc+0">PMID 6529536</font></a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Domperidone+and+levodopa+in+Parkinson%27s+disease&amp;rft.jtitle=British+journal+of+clinical+pharmacology&amp;rft.aulast=Shindler+JS%2C+Finnerty+GT%2C+Towlson+K%2C+Dolan+AL%2C+Davies+CL%2C+Parkes+JD&amp;rft.au=Shindler+JS%2C+Finnerty+GT%2C+Towlson+K%2C+Dolan+AL%2C+Davies+CL%2C+Parkes+JD&amp;rft.date=December+1984&amp;rft.volume=18&amp;rft.issue=6&amp;rft.pages=959%E2%80%9362&amp;rft_id=info:pmid/6529536&amp;rfr_id=info:sid/en.wikipedia.org:Domperidone"><span style="DISPLAY: none">&nbsp;</span></span> </li> <li id="cite_note-Rossi-3"><strong><a title="" href="#cite_ref-Rossi_3-0"><font colorsize="#0066cc+0">^</font></a></strong> Rossi S, editor. <a title="Australian Medicines Handbook" href="/wiki/Australian_Medicines_Handbook"><font colorsize="#0066cc+0">Australian Medicines Handbook</font></a> 2006. Adelaide: Australian Medicines Handbook; 2006. </li> <li id="cite_note-pmid9663360-4"><strong><a title="" href="#cite_ref-pmid9663360_4-0"><font colorsize="#0066cc+0">^</font></a></strong> <cite style="FONT-STYLE: normal" id="CITEREFSilvers_D.2C_Kipnes_M.2C_Broadstone_V.2C_.27.27et_al..27.271998">Silvers D, Kipnes M, Broadstone V, <em>et al.</em> (1998). &quot;Domperidone in the management of symptoms of diabetic gastroparesis: efficacy, tolerability, and quality-of-life outcomes in a multicenter controlled trial. DOM-USA-5 Study Group&quot;. <em>Clinical therapeutics</em> <strong>20</strong> (3): 438&ndash;53. <a title="Digital object identifier" href="/wiki/Digital_object_identifier"><font colorsize="#0066cc+0">doi</font></a>:<span class="neverexpand"><a class="external text" title="http://dx.doi.org/10.1016%2FS0149-2918%2898%2980054-4" rel="nofollow" href="http://dx.doi.org/10.1016%2FS0149-2918%2898%2980054-4"><font colorsize="#0066cc+0">10.1016/S0149-2918(98)80054-4</font></a></span>. <a class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/9663360" href="http://www.ncbi.nlm.nih.gov/pubmed/9663360"><font colorsize="#0066cc+0">PMID 9663360</font></a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Domperidone+in+the+management+of+symptoms+of+diabetic+gastroparesis%3A+efficacy%2C+tolerability%2C+and+quality-of-life+outcomes+in+a+multicenter+controlled+trial.+DOM-USA-5+Study+Group&amp;rft.jtitle=Clinical+therapeutics&amp;rft.aulast=Silvers+D%2C+Kipnes+M%2C+Broadstone+V%2C+%27%27et+al.%27%27&amp;rft.au=Silvers+D%2C+Kipnes+M%2C+Broadstone+V%2C+%27%27et+al.%27%27&amp;rft.date=1998&amp;rft.volume=20&amp;rft.issue=3&amp;rft.pages=438%E2%80%9353&amp;rft_id=info:doi/10.1016%2FS0149-2918%2898%2980054-4&amp;rft_id=info:pmid/9663360&amp;rfr_id=info:sid/en.wikipedia.org:Domperidone"><span style="DISPLAY: none">&nbsp;</span></span> </li> <li id="cite_note-5"><strong><a title="" href="#cite_ref-5"><font colorsize="#0066cc+0">^</font></a></strong> <a class="external text" title="http://www.cmaj.ca/cgi/content/full/171/7/725" rel="nofollow" href="http://www.cmaj.ca/cgi/content/full/171/7/725"><em><font colorsize="#0066cc+0">Domperidone for lactating women</font></em></a>, Canadian Medical Association Journal, Orlando P. da Silva and David C. Knoppert. 2004 Sep 28;171(7):725-6. </li> <li id="cite_note-fda-warn-6">^ <a title="" href="#cite_ref-fda-warn_6-0">^{<em><strong><font color="#0066cc" size="2">a</font></strong></em>}</a> <a title="" href="#cite_ref-fda-warn_6-1">^{<em><strong><font color="#0066cc" size="2">b</font></strong></em>}</a> <a class="external text" title="http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01292.html" rel="nofollow" href="http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01292.html"><font colorsize="#0066cc+0">FDA Warns Against Women Using Unapproved Drug, Domperidone, to Increase Milk Production</font></a> <a class="mw-redirect" title="Food and Drug Administration" href="/wiki/Food_and_Drug_Administration"><font colorsize="#0066cc+0">FDA</font></a> </li> <li id="cite_note-7"><strong><a title="" href="#cite_ref-7"><font colorsize="#0066cc+0">^</font></a></strong> <a class="external text" title="http://digestivedistress.com/pdf/letter_to_fda_final.pdf" rel="nofollow" href="http://digestivedistress.com/pdf/letter_to_fda_final.pdf"><font colorsize="#0066cc+0">Letter to Consumer Safety Office, FDA</font></a> Gastroparesis and Dysmotilities Association </li> <li id="cite_note-8"><strong><a title="" href="#cite_ref-8"><font colorsize="#0066cc+0">^</font></a></strong> <a class="external text" title="http://www.ncbi.nlm.nih.gov/pubmed/18589449?dopt=Abstract" rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18589449?dopt=Abstract"><font colorsize="#0066cc+0">Journal of Pediatrics 2008</font></a> </li> <li id="cite_note-9"><strong><a title="" href="#cite_ref-9"><font colorsize="#0066cc+0">^</font></a></strong> <a class="external text" title="http://www.breastfeedingonline.com/OfficialDomStatements.shtml" rel="nofollow" href="http://www.breastfeedingonline.com/OfficialDomStatements.shtml"><font colorsize="#0066cc+0">Official Statements From Prominent Physicians</font></a> breastfeedingonline.com </li> <li id="cite_note-10"><strong><a title="" href="#cite_ref-10"><font colorsize="#0066cc+0">^</font></a></strong> <a class="external text" title="http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6" rel="nofollow" href="http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6"><font colorsize="#0066cc+0">Maternal Medication Usually Compatible With Breastfeeding</font></a> American Academy of Pediatrics </li> <li id="cite_note-11"><strong><a title="" href="#cite_ref-11"><font colorsize="#0066cc+0">^</font></a></strong> <a class="external text" title="http://news.scotsman.com/topics.cfm?tid=875&amp;id=1746852006" rel="nofollow" href="http://news.scotsman.com/topics.cfm?tid=875&amp;id=1746852006"><font colorsize="#0066cc+0">Current news coverage of latest trial</font></a> The Scotsman </li> <li id="cite_note-pmid18589449-12"><strong><a title="" href="#cite_ref-pmid18589449_12-0"><font colorsize="#0066cc+0">^</font></a></strong> <cite style="FONT-STYLE: normal" id="CITEREFDjeddi_D.2C_Kongolo_G.2C_Lefaix_C.2C_Mounard_J.2C_L.C3.A9k.C3.A9_A.2008">Djeddi D, Kongolo G, Lefaix C, Mounard J, L&eacute;k&eacute; A. (2008). &quot;Effect of domperidone on QT interval in neonates.&quot;. <em>Journal of Pediatrics</em> <strong>153</strong> (5): 596-598. <a class="external" title="http://www.ncbi.nlm.nih.gov/pubmed/18589449" href="http://www.ncbi.nlm.nih.gov/pubmed/18589449"><font colorsize="#0066cc+0">PMID 18589449</font></a>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=Effect+of+domperidone+on+QT+interval+in+neonates.&amp;rft.jtitle=Journal+of+Pediatrics&amp;rft.aulast=Djeddi+D%2C+Kongolo+G%2C+Lefaix+C%2C+Mounard+J%2C+L%C3%A9k%C3%A9+A.&amp;rft.au=Djeddi+D%2C+Kongolo+G%2C+Lefaix+C%2C+Mounard+J%2C+L%C3%A9k%C3%A9+A.&amp;rft.date=2008&amp;rft.volume=153&amp;rft.issue=5&amp;rft.pages=596-598&amp;rft_id=info:pmid/18589449&amp;rfr_id=info:sid/en.wikipedia.org:Domperidone"><span style="DISPLAY: none">&nbsp;</span></span> </li> <li id="cite_note-13"><strong><a title="" href="#cite_ref-13"><font colorsize="#0066cc+0">^</font></a></strong> <cite style="FONT-STYLE: normal" class="web"><a class="external text" title="http://pdsp.med.unc.edu/pdsp.php" rel="nofollow" href="http://pdsp.med.unc.edu/pdsp.php"><font colorsize="#0066cc+0">&quot;PDSP Ki Database&quot;</font></a><span class="printonly">. <a class="external free" title="http://pdsp.med.unc.edu/pdsp.php" rel="nofollow" href="http://pdsp.med.unc.edu/pdsp.php"><font colorsize="#0066cc+0">http://pdsp.med.unc.edu/pdsp.php</font></a></span>.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&amp;rft.genre=bookitem&amp;rft.btitle=PDSP+Ki+Database&amp;rft.atitle=&amp;rft_id=http%3A%2F%2Fpdsp.med.unc.edu%2Fpdsp.php&amp;rfr_id=info:sid/en.wikipedia.org:Domperidone"><span style="DISPLAY: none">&nbsp;</span></span> </li>