Motilium (domperidone) is a dopamine antagonist medication specifically formulated to address symptoms of impaired gastric motility. It is widely prescribed by healthcare professionals to manage conditions such as gastroparesis, functional dyspepsia, and nausea/vomiting of various etiologies. By enhancing the coordination and amplitude of gastric contractions and tightening the lower esophageal sphincter, it facilitates gastric emptying and reduces upper gastrointestinal discomfort. Its targeted mechanism offers a well-tolerated option for patients where prokinetic therapy is indicated, with a distinct receptor profile that minimizes certain adverse effects associated with older agents.

Features

• Active ingredient: Domperidone 10mg per tablet
• Pharmacological class: Dopamine D2 and D3 receptor antagonist
• Formulation: Oral tablets, dispersible tablets, and suspension
• Onset of action: Typically within 30–60 minutes post-administration
• Duration of effect: Sustained prokinetic action for several hours
• Prescription status: Available by prescription in most jurisdictions
• Manufactured under strict pharmaceutical Good Manufacturing Practice (GMP) standards

Benefits

• Accelerates gastric emptying, reducing feelings of early satiety and postprandial fullness
• Effectively alleviates symptoms of nausea and vomiting through central and peripheral antiemetic actions
• Improves overall quality of life for patients with chronic dyspeptic and gastroparetic symptoms
• Exhibits a favorable side effect profile with minimal penetration of the blood-brain barrier, reducing risk of extrapyramidal symptoms
• Supports nutritional intake and medication absorption by improving gastrointestinal transit
• May be used in combination with other gastroprotective or acid-suppressing agents for comprehensive management

Common use

Motilium is commonly prescribed for the management of symptoms associated with delayed gastric emptying. This includes functional dyspepsia characterized by postprandial distress, early satiety, and epigastric pain or burning. It is also indicated for the relief of nausea and vomiting, particularly when related to diabetic gastroparesis, drug-induced nausea, or postoperative recovery. In some cases, it is used off-label to support lactation by addressing dopamine-mediated suppression of prolactin, though this application requires careful risk-benefit assessment. Clinical use should always align with approved indications and current therapeutic guidelines.

Dosage and direction

The standard adult dosage is 10mg taken three to four times daily, preferably 15–30 minutes before meals and at bedtime. Maximum daily intake should not exceed 30mg (or 40mg in some specific cases under close supervision). For pediatric patients, dosing is weight-based, typically 0.25–0.5mg/kg per dose, up to three times daily. Tablets should be swallowed whole with water; dispersible formulations may be placed on the tongue or dissolved in water. Treatment duration should be the shortest necessary to control symptoms, and long-term use requires periodic reevaluation. Dosage adjustments are necessary in hepatic impairment.

Precautions

Use with caution in patients with pre-existing liver disease due to metabolism via CYP3A4. Electrolyte imbalances (particularly hypokalemia or hypomagnesemia) should be corrected prior to initiation. Avoid use in patients with known or suspected gastrointestinal obstruction, perforation, or hemorrhage. Caution is advised in elderly patients due to potential for QT interval prolongation and increased risk of cardiac events. Patients should be monitored for signs of hyperprolactinemia, such as galactorrhea or menstrual irregularities. Not recommended during pregnancy unless clearly needed and after thorough benefit-risk discussion.

Contraindications

Hypersensitivity to domperidone or any excipients in the formulation. Concomitant use with potent CYP3A4 inhibitors such as ketoconazole, erythromycin, or ritonavir. Known pre-existing prolongation of cardiac conduction intervals, especially QT interval. Significant electrolyte disturbances. Presence of prolactinoma or known pituitary tumors. Severe hepatic impairment. Conditions associated with increased risk of ventricular arrhythmia or sudden cardiac death.

Possible side effect

Common side effects include dry mouth, headache, and mild abdominal cramps. Less frequently, patients may experience diarrhea, nervousness, or drowsiness. Elevated prolactin levels may lead to galactorrhea, breast enlargement, or menstrual changes. Rare but serious adverse effects include QT prolongation, ventricular arrhythmia, and anaphylactic reactions. Extrapyramidal symptoms are uncommon due to limited central penetration but may occur, especially at high doses or in susceptible individuals. Any signs of cardiac arrhythmia require immediate discontinuation and medical evaluation.

Drug interaction

Potent inhibitors of CYP3A4 (e.g., azole antifungals, macrolide antibiotics, protease inhibitors) significantly increase domperidone plasma levels and are contraindicated. Concurrent use with other QT-prolonging agents (e.g., certain antipsychotics, antiarrhythmics, fluoroquinolones) may amplify cardiac risks. Anticholinergic drugs may antagonize the prokinetic effects of domperidone. Use with dopamine agonists (e.g., bromocriptine) may reduce efficacy. Caution is advised with other centrally acting antiemetics due to potential additive effects.

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 one. Consistent timing relative to meals is important for optimal therapeutic effect, so patients should strive to maintain a routine.

Overdose

Symptoms of overdose may include agitation, confusion, seizures, and significant QT prolongation leading to arrhythmias. Management is primarily supportive and symptomatic. Gastric lavage may be considered if ingestion was recent. Cardiac monitoring is essential in suspected overdose. There is no specific antidote; treatment should focus on maintaining vital functions and correcting any electrolyte abnormalities. Activated charcoal may be administered if presented early after ingestion.

Storage

Store at room temperature (15–30°C) in a dry place, protected from light and moisture. Keep in the original container with the lid tightly closed. Do not transfer to alternative packaging. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Do not flush or dispose of in household trash; return unused or expired medication to a pharmacy take-back program.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or altering any medication regimen. Dosage, indications, and safety information may vary by region and are subject to change based on emerging evidence or regulatory decisions. The prescriber is responsible for verifying current prescribing guidelines and patient-specific factors.

Reviews

Clinical studies and meta-analyses have demonstrated the efficacy of domperidone in improving gastric emptying and reducing dyspeptic symptoms. It is generally well-tolerated, with a lower incidence of central nervous system effects compared to metoclopramide. However, post-marketing surveillance has highlighted cardiovascular risks at higher doses or in vulnerable populations, leading to revised dosing recommendations in many countries. Patient-reported outcomes often indicate significant improvement in meal-related comfort and reduction in nausea. Long-term safety data remain limited, underscoring the need for periodic reassessment during extended therapy.