India · Paediatric mg/kg & Adult · Nausea · Vomiting · Gastroparesis · GERD · Domstal · Vomistop · Domperi
✗ Age under 1 year
✗ Cardiac arrhythmia / long QT
✗ Severe hepatic impairment
⚠️ With azithromycin, ondansetron, haloperidol (QT)
⚠️ Hypokalaemia — correct before use
💊 Avoid >4 weeks continuous use
| Patient | Dose | Frequency | Max/day | Duration |
|---|---|---|---|---|
| Child 1–12 yr (≥ 1 year only) | 0.25–0.5 mg/kg/dose | Three times daily (TDS) before meals | 30 mg/day or 2.4 mg/kg | Max 4 weeks |
| Adult / adolescent ≥12 yr | 10 mg | Three times daily before meals (TDS) | 30 mg/day | Max 4 weeks |
| Adult — gastroparesis | 10 mg | Three times daily + 10 mg at bedtime | 40 mg/day (specialist) | Specialist review at 4 weeks |
| Adult — migraine adjunct | 10 mg | Single dose with analgesic | 10 mg per episode | PRN |
| Adult — lactation (off-label) | 10 mg | Three times daily | 30 mg/day | Max 4 weeks; lowest effective dose |
| All ages | Contraindicated under 1 year · No IV formulation available in India | |||
Domperidone is the most widely prescribed antiemetic and prokinetic agent in India and is available over-the-counter (OTC) in many Indian pharmacies as Domstal, Vomistop, and Domperi. It works as a peripheral D2-receptor antagonist — blocking dopamine-mediated inhibition of gastric motility and stimulating upper GI motility (prokinetic effect), while also blocking the chemoreceptor trigger zone (CTZ) in the area postrema to produce antiemetic effects. Critically, domperidone has minimal penetration of the blood-brain barrier, distinguishing it from metoclopramide and giving it a much lower risk of extrapyramidal side effects (dystonia, tardive dyskinesia).
The MHRA and EMA both contraindicate domperidone in children under 1 year (or under 35 weeks corrected gestational age for preterm infants). The immature blood-brain barrier in young infants allows significantly higher CNS and cardiac penetration of domperidone, leading to an increased risk of serious ventricular arrhythmias and sudden death. Multiple case reports of fatal cardiac events have been documented in infants given domperidone, including at doses considered "standard" in older children. In India, where domperidone is available OTC and widely used for infant colic and vomiting, this contraindication is critically important to communicate to parents and prescribers. For vomiting in infants under 1 year, ondansetron (under specialist guidance) is the safer alternative.
Domperidone causes dose-dependent QTc prolongation. The risk is greatest at high doses, in patients with pre-existing long QT syndrome or hypomagnesaemia/hypokalaemia, and in combination with other QT-prolonging drugs. The most clinically relevant interaction in India is with azithromycin — a combination frequently encountered when treating gastroenteritis with presumed infectious aetiology. Both drugs independently prolong QTc and the combination has additive effect. If both are genuinely indicated, consider sequential use (complete azithromycin before starting domperidone) or substitute ondansetron for domperidone.
India has a proliferation of fixed-dose combination tablets combining domperidone with PPIs — Pan-D (pantoprazole 40 mg + domperidone 10 mg), Omez-D, Domstal-PZ, and many others. These are widely prescribed and used OTC for dyspepsia, GERD, and upper abdominal bloating. While the combination addresses both acid secretion and gastric motility, fixed-dose combinations do not allow independent dose adjustment, cannot be used in children, and expose patients to domperidone's cardiac risks even when the indication may only require a PPI. Reserve these combinations for adult patients with symptomatic gastroparesis or GERD with concurrent nausea — avoid automatic prescription without indication review.