Motilium
Generic Name
Domperidone
Manufacturer
Janssen-Cilag
Country
Belgium (original), various countries for generics
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| motilium 10 mg tablet | ৳ 2.00 | ৳ 20.00 |
Description
Overview of the medicine
Motilium 10 mg tablet contains domperidone, an antiemetic and prokinetic agent used to treat nausea, vomiting, and certain digestive disorders like dyspepsia and gastroparesis.
Uses & Indications
Dosage
Adults
10 mg up to three times daily, 15-30 minutes before meals. Maximum daily dose is 30 mg. Treatment duration should generally not exceed one week for acute nausea/vomiting.
Elderly
Same as adults, but caution is advised due to potential cardiac risks; use the lowest effective dose for the shortest duration. Maximum 10 mg twice daily for long-term use.
Renal_impairment
Dose frequency should be reduced to once or twice daily depending on the severity of impairment. For severe impairment (CrCl < 30 mL/min), initial dosage is 10 mg once or twice daily.
How to Take
Oral. Tablets should be taken 15-30 minutes before meals. Do not chew or crush the tablet.
Mechanism of Action
Domperidone acts as a peripheral dopamine D2 receptor antagonist, primarily in the chemoreceptor trigger zone (CTZ) and in the stomach. By blocking dopamine receptors, it prevents nausea and vomiting, and increases gastrointestinal motility and tone, facilitating gastric emptying and reducing reflux.
Pharmacokinetics
Onset
30-60 minutes
Excretion
About 66% excreted in feces and 33% in urine as metabolites, with only a small fraction as unchanged drug.
Half life
Approximately 7-9 hours (prolonged in severe renal impairment)
Absorption
Rapidly absorbed after oral administration, peak plasma concentrations reached within 30-60 minutes. Bioavailability is low (around 15%) due to extensive first-pass metabolism.
Metabolism
Extensive hepatic metabolism via N-dealkylation and oxidative hydroxylation, primarily by CYP3A4.
Side Effects
Contraindications
- Hypersensitivity to domperidone or any component
- Prolactin-releasing pituitary tumour (prolactinoma)
- Moderate to severe hepatic impairment
- Known existing prolongation of cardiac conduction intervals (e.g., QTc), particularly in patients with significant underlying cardiac disease
- Concomitant use with potent CYP3A4 inhibitors that prolong the QT interval
- Conditions where stimulation of gastrointestinal motility could be harmful (e.g., gastrointestinal hemorrhage, mechanical obstruction, perforation)
Drug Interactions
Antacids and acid-suppressing agents (e.g., PPIs, H2 blockers)
May reduce the oral bioavailability of domperidone. Should be taken after domperidone or at a different time.
QT-prolonging drugs (e.g., some antiarrhythmics, antipsychotics, antidepressants)
Increased risk of cardiac arrhythmias. Concomitant use should be avoided or used with extreme caution.
Potent CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, clarithromycin, ritonavir)
Increased domperidone plasma levels and increased risk of QT prolongation. Concomitant use is contraindicated.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include somnolence, disorientation, extrapyramidal reactions, and potential cardiac arrhythmias. Treatment is symptomatic and supportive, including gastric lavage, activated charcoal, and close monitoring of cardiac function.
Pregnancy & Lactation
Pregnancy: Use only if potential benefit justifies potential risk. Lactation: Domperidone is excreted in breast milk in small amounts. Weigh benefit vs. risk; generally not recommended unless benefits outweigh risks. Consult a doctor.
Side Effects
Contraindications
- Hypersensitivity to domperidone or any component
- Prolactin-releasing pituitary tumour (prolactinoma)
- Moderate to severe hepatic impairment
- Known existing prolongation of cardiac conduction intervals (e.g., QTc), particularly in patients with significant underlying cardiac disease
- Concomitant use with potent CYP3A4 inhibitors that prolong the QT interval
- Conditions where stimulation of gastrointestinal motility could be harmful (e.g., gastrointestinal hemorrhage, mechanical obstruction, perforation)
Drug Interactions
Antacids and acid-suppressing agents (e.g., PPIs, H2 blockers)
May reduce the oral bioavailability of domperidone. Should be taken after domperidone or at a different time.
QT-prolonging drugs (e.g., some antiarrhythmics, antipsychotics, antidepressants)
Increased risk of cardiac arrhythmias. Concomitant use should be avoided or used with extreme caution.
Potent CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, clarithromycin, ritonavir)
Increased domperidone plasma levels and increased risk of QT prolongation. Concomitant use is contraindicated.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include somnolence, disorientation, extrapyramidal reactions, and potential cardiac arrhythmias. Treatment is symptomatic and supportive, including gastric lavage, activated charcoal, and close monitoring of cardiac function.
Pregnancy & Lactation
Pregnancy: Use only if potential benefit justifies potential risk. Lactation: Domperidone is excreted in breast milk in small amounts. Weigh benefit vs. risk; generally not recommended unless benefits outweigh risks. Consult a doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date
Availability
Pharmacies, hospitals
Approval Status
Approved by health authorities worldwide (e.g., EMA, DGDA in Bangladesh)
Patent Status
Off-patent
Clinical Trials
Extensive clinical trials have demonstrated domperidone's efficacy in treating nausea, vomiting, and dyspepsia. Recent trials have also focused on safety profiles, particularly concerning cardiac risks, leading to dose adjustments and warnings.
Lab Monitoring
- Electrolyte levels (especially potassium and magnesium) in patients at risk of cardiac events
- ECG monitoring for patients with pre-existing cardiac conditions or those on concomitant QT-prolonging drugs
Doctor Notes
- Carefully assess cardiac risk factors (e.g., QTc prolongation, underlying heart conditions, concomitant QT-prolonging drugs) before prescribing.
- Use the lowest effective dose for the shortest duration, generally not exceeding one week for acute indications.
- Advise patients to report any cardiac symptoms immediately.
Patient Guidelines
- Take 15-30 minutes before meals.
- Do not exceed the recommended dose.
- Inform your doctor about all other medications, especially heart medications or antifungals.
- Seek immediate medical attention if you experience palpitations, dizziness, or fainting.
- Do not stop treatment abruptly without consulting your doctor.
Missed Dose Advice
If a dose is missed, take it as soon as you remember, unless it is almost time for your next dose. Do not take a double dose to make up for a missed one.
Driving Precautions
Domperidone may cause dizziness or drowsiness in some individuals. Patients should be advised not to drive or operate machinery if they experience these effects.
Lifestyle Advice
- Avoid fatty foods, which can delay gastric emptying.
- Eat smaller, more frequent meals.
- Avoid lying down immediately after eating.
- Manage stress, as it can worsen digestive symptoms.
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