Domperidone — NZ Medication Guide

📋 Reviewed by a Registered Pharmacist NZ — This information is for general educational purposes only and does not replace professional medical advice. Always consult your doctor or pharmacist before starting, stopping, or changing any medication.

What is Domperidone?

Domperidone is a peripheral dopamine D2 receptor antagonist used as an antiemetic and prokinetic agent. This medication is funded by Pharmac; restricted to lowest effective dose and shortest duration due to cardiac safety concerns.

What is Domperidone Used For?

Domperidone is used for nausea and vomiting (including that associated with migraine, chemotherapy, and gastroparesis), gastric dysmotility, and as a prokinetic to accelerate gastric emptying. It is also used to promote lactation (off-label).

How Does Domperidone Work?

Domperidone blocks dopamine D2 receptors in the chemoreceptor trigger zone (CTZ) and in the gastric wall. Unlike metoclopramide, it does not significantly cross the blood-brain barrier and therefore has a lower risk of central extrapyramidal side effects. Its peripheral action accelerates gastric emptying.

How to Take Domperidone

10 mg three times daily, 15–30 minutes before meals. Maximum 30 mg/day. Use at the lowest effective dose for the shortest time. Domperidone is not recommended for long-term use due to cardiac risk.

Common Side Effects of Domperidone

• Dry mouth
• Headache
• Diarrhoea
• Raised prolactin levels (galactorrhoea, menstrual irregularities)

Serious Side Effects — Seek Medical Attention

Contact your doctor or call 111 immediately if you experience any of the following:

• QT prolongation and potentially fatal cardiac arrhythmias (torsades de pointes — particularly at doses above 30 mg/day, in elderly patients, and with QT-prolonging medicines)
• Sudden cardiac death (with high doses — prompted Medsafe and regulatory safety reviews)

Drug Interactions

Domperidone may interact with other medicines. Always inform your doctor and pharmacist of all medications you are taking. Key interactions include:

• QT-prolonging medicines (antiarrhythmics, fluconazole, erythromycin, clarithromycin — significantly increased cardiac risk — contraindicated)
• Strong CYP3A4 inhibitors (increase domperidone levels)

New Zealand Prescribing Information

Domperidone (10 mg tablets — Motilium® and generics) is funded by Pharmac. Due to QT-prolongation concerns and reported sudden cardiac death cases, Medsafe and international regulatory bodies recommend: maximum dose 30 mg/day (10 mg three times daily), use in adults only for short periods, and avoidance in those with cardiac disease or taking QT-prolonging medicines. It is the subject of a Medicines Adverse Reactions Committee (MARC) safety review in NZ.

Frequently Asked Questions

Is domperidone safe for promoting breastfeeding?

Domperidone is used off-label to increase milk supply in breastfeeding women. While it raises prolactin levels and can increase milk production, Medsafe and international agencies note cardiac safety concerns — particularly QT prolongation. This use should be discussed with a prescriber who can assess individual cardiac risk factors.

Why has domperidone had safety warnings?

Regulatory agencies including Medsafe noted an association between domperidone use (particularly at doses >30 mg/day or in elderly patients) and serious cardiac arrhythmias and sudden cardiac death. This led to recommendations to use the lowest effective dose for the shortest duration and to avoid it in those with cardiac risk factors or taking other QT-prolonging medicines.

References & Further Information

The following New Zealand and international resources were used to inform this page. We encourage you to consult these authoritative sources for the most current information:

• Medsafe — Domperidone Safety Review
• New Zealand Formulary — Domperidone
• Pharmac Funded Medicines Schedule

⚠️ Disclaimer: This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or a qualified health provider. In New Zealand, medication availability and funding may vary — check with Pharmac or your pharmacist for current information.

Reviewed by a Registered Pharmacist NZ