Adults

For nausea and vomiting: 10 mg up to three times daily, 15-30 minutes before meals. Maximum duration of treatment should not usually exceed one week. Maximum daily dose is 30 mg.

Elderly

No specific dose adjustment is required in elderly patients with normal renal function, but caution is advised due to potential cardiac risks. The lowest effective dose for the shortest duration should be used.

Renal_impairment

In severe renal impairment (creatinine clearance < 30 mL/min), the dosing frequency should be reduced to once or twice daily, depending on the severity of impairment. Careful monitoring is necessary.

Onset

Anti-emetic effect usually within 30-60 minutes.

Excretion

Approximately 66% excreted in feces (mainly as metabolites) and 33% in urine (mainly as metabolites) over several days.

Half life

Approximately 7-9 hours in healthy subjects, prolonged in patients with severe renal impairment.

Absorption

Rapidly absorbed after oral administration, but has low oral bioavailability (about 15%) due to extensive first-pass metabolism in the gut wall and liver. Peak plasma concentrations are reached within 30-60 minutes.

Metabolism

Extensively metabolized in the liver by hydroxylation and N-dealkylation, primarily via CYP3A4. Conjugation reactions also occur.

Antacids and Antisecretory agents (e.g., PPIs, H2 blockers)

Can reduce the oral bioavailability of domperidone. Should be taken after meals, while domperidone should be taken before meals. If co-administered, domperidone should be taken before meals and the antacid/antisecretory agent after meals.

QT-prolonging drugs (e.g., Amiodarone, Cisapride, Haloperidol)

Concomitant use is contraindicated due to increased risk of cardiac arrhythmias.

Strong CYP3A4 Inhibitors (e.g., Ketoconazole, Erythromycin, Clarithromycin, Ritonavir)

Concomitant use is contraindicated due to increased plasma levels of domperidone and increased risk of QT prolongation.