Domperidone 30–80 mg daily safe for treatment of gastroparesis

The association between domperidone at commonly prescribed doses of 30–80 mg/d and QTc prolongation is observed in only 6 percent of patients, with no case of QT interval reaching the point considered to be clinically significant, reports a study.

This finding suggests that domperidone can be safely prescribed at conventional doses for the treatment of gastroparesis, according to the authors.

Patients who received domperidone for gastroparesis between January 2012 and September 2017 at a single centre were included in the analysis. Electrocardiograms (ECGs), primarily the QTc interval, taken at baseline, 2–6 months after initiation of domperidone, 6–12 months after initiation and ≥12 months after initiation were reviewed. Concurrent QTc prolonging medications were recorded for each patient.

The primary endpoint was QTc prolongation >500 ms, while secondary ones were QTc >450 ms for males, QTc >470 ms for females, QTc prolongation ≥20 ms above baseline and QTc prolongation >60 ms above baseline.

A total of 246 patients (mean age, 46.3 years; 209 females) were analysed. ECGs were available for all 246 patients prior to treatment, for 170 at 2–6 months, for 135 at 6–12 months and for 152 at least 1 year following initiation of domperidone.

Clinically important QTc prolongation occurred in 15 patients (6.1 percent; 9 females), of whom 11 had QTc >450 ms for males or >470 ms for females. None of them had QTc prolongation >500 ms. Five patients (2.0 percent) had >60 ms over baseline, and 61 (24.7 percent) had QTc increase of ≥20 ms but <60 ms from baseline.

“Domperidone is a dopamine receptor antagonist used for the treatment of gastroparesis,” the authors noted. “However, it has been associated with QT prolongation, ventricular arrhythmias and sudden cardiac death.”