How Often Is Domperidone Prescribed With Interacting Drugs?
A recent study by Ehrenpreis and colleagues 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%).
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 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.
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Cite this: Domperidone for Gastroparesis: Beware of Drug Interactions - Medscape - Sep 11, 2017.