COMMENTARY

Domperidone for Gastroparesis: Beware of Drug Interactions

David A. Johnson, MD

Disclosures

September 11, 2017

How Often Is Domperidone Prescribed With Interacting Drugs?

A recent study by Ehrenpreis and colleagues[4] evaluated ECG monitoring and co-prescription of domperidone with other QT-prolonging drugs. Additionally, the voluntary reporting system for post-marketing adverse drug reactions reported to the FDA was reviewed for co-prescription of domperidone and interacting drugs, with specific reports of cardiac toxicities (arrhythmias and death).

They found that 108 of 155 patients (69.7%) were prescribed QT-interacting drugs concomitantly with domperidone. Only 38.1% underwent a baseline ECG and 15.3% had prolongation of the QT interval at initiation. Follow-up ECG was done in 25.8%, of which 32.5% had prolongation of the QT interval. Notably, all of these patients were co-prescribed QT-interacting medications.

From the FDA reporting system review, the authors found that 221 nonfatal cardiac events were reported in patients receiving domperidone, with 73.3% occurrence in patients receiving QT-interacting medications. Of particular note, co-prescription occurred in 53 of 151 deaths (35.1%) and in 16 of 61 cardiac arrests (26.2%).

Recommendations

Co-prescribing of QT-prolonging medications and inconsistent ECG monitoring occur in many patients receiving domperidone. Hence, it is important to be familiar with possible drug-drug interactions and appropriate monitoring of these patients.

In our EMR, warnings for domperidone drug interactions do not appear because it is not an FDA-approved drug and is not included in the drug library. It is critical that physicians providing care to patients with gastroparesis are aware that medications with QT-prolonging potential should not be prescribed in combination with domperidone.

I strongly suggest that clinicians make sure their patients on domperidone know to tell all of their other providers that they are on domperidone. Cross-checking for drug interactions is needed for any concomitant medication. This present study[4] provides a list of interacting medications, which is a valuable resource for prescribers and patients.

Physicians interested in submitting an expanded-access investigational new drug application (IND) for domperidone can download the Domperidone IND Packet, which contains the required forms, instructions, and answers to most questions.

Follow Medscape on Twitter: @Medscape

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....