Motilium (domperidone) is a dopamine antagonist medication specifically formulated to address disorders of gastric motility, including delayed gastric emptying, gastroesophageal reflux, and functional dyspepsia. As a peripherally selective agent, it enhances coordination of antroduodenal motility and increases lower esophageal sphincter tone without significant central nervous system penetration. This profile makes it a valuable therapeutic option for patients requiring prokinetic support with a reduced risk of extrapyramidal side effects compared to centrally-acting antiemetics. Clinical applications extend to managing nausea and vomiting associated with dopamine agonist therapy in Parkinson’s disease, under appropriate supervision.

Features

• Active ingredient: Domperidone 10 mg per tablet
• Pharmacologic class: Dopamine D₂ and D₃ receptor antagonist
• Peripheral selectivity with limited blood-brain barrier penetration
• Tablet formulation for oral administration
• Typically administered before meals for optimal effect
• Onset of action within 30-60 minutes post-administration

Benefits

• Accelerates gastric emptying and improves gastroduodenal coordination
• Reduces symptoms of postprandial fullness, early satiety, and bloating
• Decreases episodes of gastroesophageal reflux through enhanced esophageal clearance
• Provides antiemetic effects without significant sedation
• May improve tolerance to enteral nutrition in patients with motility disorders
• Alternative for patients who cannot tolerate or have contraindications to metoclopramide

Common use

Motilium is primarily indicated for the relief of symptoms associated with delayed gastric emptying, including chronic postprandial distress, nausea, vomiting, bloating, and epigastric discomfort. It is commonly prescribed for diabetic gastroparesis, functional dyspepsia, and gastroesophageal reflux disease that has proven refractory to conventional acid suppression therapy. In neurological practice, it is utilized to counter dopamine agonist-induced nausea and vomiting in Parkinson’s disease patients. Off-label applications include management of chemotherapy-induced nausea and vomiting, though this requires careful risk-benefit assessment.

Dosage and direction

The standard adult dosage is 10 mg three to four times daily, taken 15-30 minutes before meals and at bedtime. Maximum daily dosage should not exceed 30 mg for most indications, though some clinical scenarios may warrant 40 mg daily under close monitoring. For nausea and vomiting prevention, administration should occur prior to anticipated triggers. Tablets should be swallowed whole with water, not crushed or chewed. Duration of therapy is typically limited to short-term use (generally not exceeding 12 weeks) unless continued benefits outweigh risks under specialist supervision. Pediatric dosing requires careful calculation based on body weight and should only be initiated by specialists familiar with pediatric motility disorders.

Precautions

Cardiac monitoring is advised in patients with underlying cardiovascular disease or electrolyte abnormalities due to potential QT interval prolongation. Hepatic impairment requires dosage reduction or avoidance, as domperidone undergoes extensive hepatic metabolism. Elderly patients require careful dose titration and monitoring for cardiac effects. Use with caution in patients receiving other medications that prolong QT interval or inhibit CYP3A4. Breastfeeding women should exercise caution as domperidone is excreted in breast milk. Avoid concomitant administration with anticholinergic medications that may counteract prokinetic effects. Regular reassessment of continued therapy necessity is recommended.

Contraindications

Absolute contraindications include known hypersensitivity to domperidone or any tablet excipients. Prohibited in patients with known prolongation of cardiac conduction intervals, particularly QTc >450 ms in males or >470 ms in females. Contraindicated in the presence of significant electrolyte disturbances (hypokalemia, hypomagnesemia). Should not be used in patients with moderate to severe hepatic impairment (Child-Pugh B or C). Avoid in patients with prolactinoma or pheochromocytoma. Contraindicated with concomitant strong CYP3A4 inhibitors including ketoconazole, erythromycin, and ritonavir. Not recommended in patients with gastrointestinal hemorrhage, mechanical obstruction, or perforation.

Possible side effects

Most common adverse reactions include headache (approximately 5%), dry mouth (4%), and abdominal cramps (3%). Less frequently reported effects include diarrhea, nervousness, and drowsiness. Endocrine effects may include hyperprolactinemia leading to galactorrhea, breast enlargement, or menstrual irregularities. Cardiac effects, though rare, may include palpitations, QT prolongation, and serious ventricular arrhythmias. Allergic reactions including rash, pruritus, and angioedema have been reported. Extrapyramidal symptoms are uncommon due to peripheral selectivity but may occur particularly in pediatric populations or with high doses.

Drug interaction

Strong CYP3A4 inhibitors (ketoconazole, fluconazole, clarithromycin) significantly increase domperidone exposure and are contraindicated. Moderate CYP3A4 inhibitors require dose reduction and monitoring. Anticholinergic agents may antagonize prokinetic effects. Concurrent use with other QT-prolonging agents (antiarrhythmics, antipsychotics, antidepressants) increases arrhythmia risk. Dopamine agonists used in Parkinson’s disease may have reduced efficacy. Gastric pH modifiers do not significantly affect absorption. Protein-binding interactions are unlikely due to low plasma protein binding.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. Consistent pre-meal timing is important for optimal therapeutic effect, particularly for postprandial symptom management. Patients should be advised to maintain regular dosing intervals for maximum efficacy in controlling gastrointestinal symptoms.

Overdose

Symptoms of overdose may include agitation, confusion, seizures, and extrapyramidal reactions. Cardiac manifestations include QT prolongation, torsades de pointes, and ventricular arrhythmias. Management involves immediate discontinuation, gastric lavage if presented early, and activated charcoal administration. Cardiac monitoring for at least 24 hours is essential. Treatment is supportive and symptomatic, with particular attention to cardiac status. Antiarrhythmic therapy may be required for significant QT prolongation or ventricular arrhythmias. There is no specific antidote for domperidone overdose.

Storage

Store at room temperature (15-30°C) in the original container protected from light and moisture. Keep tightly closed and away from excessive heat or humidity. Do not store in bathroom cabinets where moisture levels may fluctuate. Keep out of reach of children and pets. Do not use beyond the expiration date printed on packaging. Proper disposal of unused medication through pharmacy take-back programs is recommended to prevent accidental ingestion or environmental contamination.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Motilium is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to therapy may vary, and appropriate monitoring is essential. The prescribing physician should be aware of the latest safety information regarding domperidone, particularly concerning cardiac risk factors. Patients should not adjust dosage or discontinue medication without consulting their healthcare provider. Always refer to the official prescribing information for complete details.

Reviews

Clinical studies demonstrate Motilium’s efficacy in improving gastric emptying parameters and reducing symptoms of functional dyspepsia. In randomized controlled trials, domperidone showed significant superiority over placebo in global symptom improvement scores (p<0.01). Gastroenterologists report satisfactory response rates in approximately 60-70% of patients with diabetic gastroparesis. Patient-reported outcomes indicate improvement in quality of life measures related to meal-related symptoms. However, recent systematic reviews emphasize the need for careful patient selection and monitoring due to cardiovascular safety concerns. Long-term efficacy data beyond 12 weeks remains limited, necessitating periodic reassessment of continued therapy.