Domperidone: Everything a Gastroenterologist Needs to Know

Marco Bustamante-Bernal MD1 Priyanka Wani MD1 Richard W. McCallum MD2 1Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Science Center 2Department of Internal Medicine, Division of Gastroenterology, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX Domperidone, first synthesized approximately 40 years ago, has been approved worldwide for specific clinical applications. However, in the United States it is only available through an FDA-approved Limited Access Program. Patients with functional dyspepsia, gastroparesis, gastroesophageal reflux disease and refractory nausea and vomiting may benefit from the use of domperidone. The main limitation to using domperidone has been questions raised regarding cardiac toxicity, specifically QTc elongation that could potentially lead to fatal arrhythmias. Recent studies have not shown a significantly increased incidence of cardiac side effects even when domperidone was given at very high doses, two to three-fold greater than those typically described in the majority of the available literature. In this article we review all the literature regarding its clinical efficacy and we provide a comprehensive list of recommendations and guidelines when considering initiating domperidone in patients that are suitable for this medication.