Domperidone

Peripheral D2 Antagonist·Gastrointestinal - Antiemetics

Nausea and vomiting, diabetic gastroparesis

Authority requiredPBSANTIEMETICMotilium10 mg tablet+2

Max Dose

30 mg/day

Half-life

7-9 h

QTc Risk

HIGH

BBB Penetration

NONE

Rapid Summary

Overview

Peripheral dopamine D2 antagonist. Highly effective prokinetic and antiemetic. Crucially, it does NOT cross the blood-brain barrier, making it completely free of psychiatric or EPSE side effects.

Maximum Dose

Max 30 mg/day (Strictly enforced by TGA/EMA due to cardiac risks).

Clinical Focus

The ONLY anti-nausea medication safe to prescribe to patients with Parkinson's Disease. However, carries a black box warning for fatal ventricular arrhythmias.

Bottom Line

Domperidone is a peripheral dopamine antagonist antiemetic and prokinetic that does not cross the blood-brain barrier, but prolongs QTc and carries cardiovascular risk especially in elderly.

Formulation & Access

Brand Names

Motilium

Oral Routes

Tablets (10 mg).

Prescribing & PBS

Authority Required (PBS). Restricted to 1-week supply in many jurisdictions to prevent chronic cardiac toxicity.

Indications & Use

Primary

PBSTGA

Nausea and vomiting, diabetic gastroparesis.

Off-Label

OFF

Stimulation of lactation (galactagogue) in breastfeeding mothers.

Clinical Place

The mandatory antiemetic for Parkinson's patients (as Metoclopramide and Prochlorperazine will paralyze them).

Quick reference

Class & Role

Peripheral D2 Antagonist — Peripheral dopamine D2 antagonist.

Route / Formulation

Tablets (10 mg). (Motilium)

Usual Dose & Max

PO 10 mg up to TDS. Must be taken 15-30 mins BEFORE meals to exert prokinetic effect. Max 30 mg/day.

Key Indication Doses

Nausea / Gastroparesis: PO 10 mg up to TDS. Must be taken 15-30 mins BEFORE meals to exert prokinetic effect. Max 30 mg/day. Renal Impairment: Reduce dose frequency to OD or BD if eGFR < 30.

Best Uses

Domperidone is a peripheral dopamine antagonist antiemetic and prokinetic that does not cross the blood-brain barrier, but prolongs QTc and carries cardiovascular risk especially in elderly.

Avoid / Cautions

Baseline QTc > 450 ms, significant heart disease, severe hepatic impairment, mechanical bowel obstruction. Pregnancy Category B2. Often prescribed off-label postpartum for lactation.

Key Risks

Cardiovascular: QTc prolongation, ventricular fibrillation, sudden cardiac death (Risk increases exponentially at doses > 30 mg/day or age > 60). Endocrine: Hyperprolactinemia (galactorrhea, amenorrhea). Neurological: Zero EPSE, zero akathisia, zero sedation.

Key Interactions

Strong CYP3A4 inhibitors (Clarithromycin, Ketoconazole) block clearance, spiking Domperidone levels and causing lethal arrhythmias. DO NOT COMBINE. Amiodarone, Sotalol, SSRIs (Additive QTc prolongation).

Monitoring

Baseline ECG before prescribing, particularly in patients over 60 or those with a history of cardiac disease.

Clinical Pearl

If a patient on Levodopa develops severe nausea, giving them Metoclopramide will strip the dopamine off their brain receptors, causing an acute Parkinsonian crisis. Domperidone only blocks dopamine in the gut, curing the nausea while preserving brain function.

Access

Authority requiredMotilium10 mg tablet

Brand: Motilium
PBS status: Authority required
Formulation: Tablets (10 mg)

Domperidone

Peripheral D2 Antagonist·Gastrointestinal - Antiemetics

Nausea and vomiting, diabetic gastroparesis

Authority requiredPBSANTIEMETICMotilium10 mg tablet+2

Max Dose

30 mg/day

Half-life

7-9 h

QTc Risk

HIGH

BBB Penetration

NONE

Rapid Summary

Overview

Peripheral dopamine D2 antagonist. Highly effective prokinetic and antiemetic. Crucially, it does NOT cross the blood-brain barrier, making it completely free of psychiatric or EPSE side effects.

Maximum Dose

Max 30 mg/day (Strictly enforced by TGA/EMA due to cardiac risks).

Clinical Focus

The ONLY anti-nausea medication safe to prescribe to patients with Parkinson's Disease. However, carries a black box warning for fatal ventricular arrhythmias.

Bottom Line

Domperidone is a peripheral dopamine antagonist antiemetic and prokinetic that does not cross the blood-brain barrier, but prolongs QTc and carries cardiovascular risk especially in elderly.

Formulation & Access

Brand Names

Motilium

Oral Routes

Tablets (10 mg).

Prescribing & PBS

Authority Required (PBS). Restricted to 1-week supply in many jurisdictions to prevent chronic cardiac toxicity.

Indications & Use

Primary

PBSTGA

Nausea and vomiting, diabetic gastroparesis.

Off-Label

OFF

Stimulation of lactation (galactagogue) in breastfeeding mothers.

Clinical Place

The mandatory antiemetic for Parkinson's patients (as Metoclopramide and Prochlorperazine will paralyze them).

Quick reference

Class & Role

Peripheral D2 Antagonist — Peripheral dopamine D2 antagonist.

Route / Formulation

Tablets (10 mg). (Motilium)

Usual Dose & Max

PO 10 mg up to TDS. Must be taken 15-30 mins BEFORE meals to exert prokinetic effect. Max 30 mg/day.

Key Indication Doses

Nausea / Gastroparesis: PO 10 mg up to TDS. Must be taken 15-30 mins BEFORE meals to exert prokinetic effect. Max 30 mg/day. Renal Impairment: Reduce dose frequency to OD or BD if eGFR < 30.

Best Uses

Domperidone is a peripheral dopamine antagonist antiemetic and prokinetic that does not cross the blood-brain barrier, but prolongs QTc and carries cardiovascular risk especially in elderly.

Avoid / Cautions

Baseline QTc > 450 ms, significant heart disease, severe hepatic impairment, mechanical bowel obstruction. Pregnancy Category B2. Often prescribed off-label postpartum for lactation.

Key Risks

Key Interactions

Monitoring

Baseline ECG before prescribing, particularly in patients over 60 or those with a history of cardiac disease.

Clinical Pearl

Access

Authority requiredMotilium10 mg tablet

Brand: Motilium
PBS status: Authority required
Formulation: Tablets (10 mg)