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PubMed2006

Study protocol: a double blind placebo controlled trial examining the effect of domperidone on the composition of breast milk [NCT00308334].

BACKGROUND: Domperidone, a drug that enhances upper gastric motility, is an anti-dopaminergic medication that also elevates prolactin levels. It has been shown to safely increase the milk supply of lactating women. To date, researchers have analyzed the effects of domperidone on lactating woman with respect to the quantity of their milk production, adverse effects, and drug levels in the breast milk. However, the effect of domperidone on the macronutrient composition of breast milk has not been studied and current guidelines for fortification of human milk for premature infants do not distinguish between those women using or those not using domperidone. The purpose of this study is to evaluate the effect of domperidone (given to lactating mothers of very preterm infants) on the macronutrient composition of breast milk. METHODS/DESIGN: Mothers of infants delivered at less than 31 weeks gestation, who are at least 3 weeks postpartum, and experiencing lactational failure despite non-pharmacological interventions, will be randomized to receive domperidone (10 mg three times daily) or placebo for a 14-day period. Breast milk samples will be obtained the day prior to beginning treatment and on days 4, 7 and 14. The macronutrient (protein, fat, carbohydrate and energy) and macromineral content (calcium, phosphorus and sodium) will be analyzed and compared between the two groups. Additional outcome measures will include milk volumes, serum prolactin levels (measured on days 0, 4, and 10), daily infant weights and breastfeeding rates at 2 weeks post study completion and at discharge. Forty-four participants will be recruited into the study. Analysis will be carried out using the intention to treat approach. DISCUSSION: If domperidone causes significant changes to the nutrient content of breast milk, an alteration in feeding practices for preterm infants may need to be made in order to optimize growth, nutrition and neurodevelopment outcomes.

Journal Article↗
PubMed1979

Effect of domperidone on gastric emptying and secretion.

Domperidone (5 mg i.v.) was given singly or together with apomorphine (0.25 mg i.v.) to healthy volunteers. The gastric emptying rate of a test meal of 750 ml of water was then measured using a dye dilution and double sampling technique. The effect of domperidone on gastric secretion was evaluated in patients with duodenal ulcer who received domperidone (5 mg i.v.) prior to continuous aspiration of the stomach contents for 120 minutes. Domperidone markedly increased the rate of emptying of the test meal. Following apomorphine the gastric emptying rate decreased and domperidone antagonized this slowing effect. The composition of gastric juice was not affected by an intravenous dose of domperidone. Domperidone appears to modulate gastric contractile activity without affecting gastric secretion.

Antiemetics↗
PubMed1987

Microwave facilitation of domperidone antagonism of apomorphine-induced stereotypic climbing in mice.

The dopaminergic agonist apomorphine produced dose-dependent stereotypic climbing behavior in mice housed in cages with vertical bars. This drug effect was competitively inhibited by systemic pretreatment with the centrally acting dopaminergic antagonist haloperidol but not by microwave irradiation (2.45 GHz, 20 mW/cm2, CW, 10 min) nor by systemic pretreatment with domperidone, a dopaminergic antagonist that only poorly penetrates the blood-brain barrier (BBB). Yet when mice were systemically pretreated with domperidone and then subjected to microwave irradiation (as above), the apomorphine effect was significantly reduced. Microwave irradiation also facilitated antagonism of the apomorphine effect by low and otherwise ineffective systemic pretreatment doses of haloperidol. Apomorphine-induced stereotypic climbing behavior was also reduced by domperidone administered intracerebrally, which bypassed the BBB. Exposure of intracerebral domperidone-pretreated animals to microwave irradiation failed to increase the degree of antagonism. These findings indicate that microwave irradiation can facilitate central effects of domperidone, a drug which acts mainly in the periphery. One possible explanation for these findings is that microwave irradiation alters the permeability of the BBB and increases the entry of domperidone to central sites of action.

Animals↗
PubMed1997

Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with Parkinson's disease.

This study investigated whether domperidone could improve gastrointestinal symptoms in patients with Parkinson's disease who were receiving levodopa therapy. A total of 11 patients were studied. Following a baseline gastric emptying test, patients were treated with a starting dose of domperidone 20 mg p.o. q.i.d. A follow-up gastric emptying test was repeated at least 4 months after starting domperidone therapy. At the beginning and at each 3-month follow-up visit, symptoms of nausea, vomiting, anorexia, abdominal bloating, heartburn, regurgitation, dysphagia, and constipation were evaluated and scored on a scale of 0-3. The overall mean follow-up period was 3 years. Compared with their baseline evaluation, patients experienced a significant improvement in all symptoms (p < 0.05) except dysphagia and constipation. Gastric emptying of an isotope-labeled solid meal was significantly faster, with a baseline result of 60.2 +/- 6.4% retention of isotope 2 h after the meal compared with 37.0 +/- 2.2% retention during domperidone therapy (p < 0.05). Patients' global assessment of Parkinson's disease remained stable or improved. Serum prolactin was elevated in all patients after domperidone therapy (p < 0.05). Domperidone therapy significantly reduces upper gastrointestinal symptoms and accelerates gastric emptying of a solid meal, but does not interfere with response to antiparkinsonism treatment.

Aged↗
PubMedDate not supplied

The prokinetic effect of domperidone in gallbladder--not upon dopaminergic receptors.

The mechanism of the contractile effect of domperidone on gallbladder smooth muscle has been investigated by using an in-vivo and an in-vitro model. In the in-vivo part of the study 14 healthy males were administered 20 mg domperidone or two placebo tablets orally and gallbladder emptying was measured by ultrasonography. The reduction in the gallbladder volume was significant compared to the placebo at 45 and 55 min. In the in-vitro part of the study, the gallbladder strips isolated from guinea pigs were field stimulated and 10(-6)-10(-4) M concentrations of dopamine were administered before electrical field stimulation (EFS) was repeated. Dopamine exerted no significant effect upon the contractions obtained by EFS. The effect of dopamine and domperidone under basal conditions were also explored. Under basal conditions, dopamine neither contracted nor relaxed the gallbladder muscle between 10(-6) and 10(-4) M concentrations when added directly to the organ bath. Besides, a significant contraction was observed with 10(-4) M concentration of domperidone whereas 10(-7), 10(-6) and 10(-5) M concentrations exerted no effect. This effect of domperidone was thought to be nonspecific but inhibited by 10(-6) M atropine, 10(-5) M pirenzepine and abolished by 10(-6) M tetrodotoxin. In summary, domperidone produces a modest contraction in human gallbladder. This effect does not seem to occur upon dopaminergic receptors in guinea pig models.

Adult↗
PubMed1988

Effects of domperidone in patients with chronic unexplained upper gastrointestinal symptoms: a double-blind, placebo-controlled study.

The effects of domperidone, a peripherally acting dopamine antagonist, were compared with those of placebo in a double-blind randomized study in 16 patients with idiopathic gastric stasis, chronic symptoms of "nonulcer dyspepsia" (including nausea, vomiting, and abdominal pain), and altered gastroduodenal motility. Patients received either domperidone or placebo orally (20 mg before meals and at bedtime) for six weeks. Symptoms were assessed by daily diaries kept by the patients for two weeks while receiving no medication for their gastrointestinal complaints (baseline), and throughout the six-week treatment phase. Studies of gastric emptying of a radiolabeled solid-phase meal were performed at baseline and six weeks after treatment. All patients had delayed gastric emptying at baseline, defined as a half-emptying time of more than mean + 1 SD (from studies of normal controls). An 18- to 24-hr recording of gastroduodenal motor function during fasting was also performed at baseline and after six weeks of either domperidone or placebo treatment. After six weeks of treatment, the symptom scores significantly improved in the domperidone group (P less than 0.05), but not in the placebo group. Gastroduodenal motor activity was unchanged from baseline recordings after six weeks. Solid-phase gastric emptying also showed no improvement in either the domperidone or placebo group of patients. Although domperidone therapy had no significant effect on motility, it appears to be an effective drug for the treatment of the symptoms of nonulcer dyspepsia.

Adult↗
PubMed1987

Effects of domperidone and thyrotropin-releasing hormone on secretion of luteinizing hormone and prolactin during the luteal phase and following induction of luteal regression in sheep.

Effects of domperidone, a peripheral dopamine receptor antagonist, on secretion of LH and prolactin were studied during the luteal phase and following administration of PGF2 alpha. Since hyperprolactinemia has been reported to inhibit secretion of LH in ewes, effects of thyrotropin-releasing hormone (TRH) also were examined. Ewes 8-10 days post-estrus were assigned to be treated with: 1) vehicle (n = 5); 2) 0.3 mg domperidone (n = 6); 3) 1.0 mg domperidone (n = 6); 4) 3 micrograms TRH (n = 6); or 5) 10 micrograms TRH (n = 6) every 4 hours for 60 hr. Luteal regression was induced with PGF2 alpha at 12 hr after initiation of treatments. During the luteal phase, pulses of LH were more frequent (P less than .05) and the amplitudes of these were higher (P less than .05) in ewes treated with domperidone or TRH than in control ewes. These changes in LH occurred even though each treatment elevated markedly concentrations of prolactin in plasma. After induction of luteal regression, mean of LH and frequency of LH discharges were similar in all groups. However, in ewes treated with the 1.0 mg/4 hr dose of domperidone the pulse amplitude was greater than in the other groups (2.3 vs 1.1 ng/ml). Dose-response relationships and the magnitude of the prolactin release following domperidone or TRH varied with time. Treatments did not affect the timing of the LH surge or the increase in progesterone associated with the subsequent cycle.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Domperidone and ventilatory behavior: Sprague-Dawley versus Brown Norway rats.

Domperidone, a dopamine D(2) receptor antagonist, is a tool for uncovering the tonic and dynamic effects of the peripheral dopaminergic system in unanesthestized animals. The hypothesis was that domperidone effects would vary between strains of the same species. Ventilatory behavior -- frequency and minute ventilation -- was measured by the plethysmographic method in unrestrained adult male Sprague-Dawley (SD: n=8) and Brown Norway (BN: n=8) rats before, during and after rapid transition to 100% O(2) after 5 min of 13% O(2)/3% CO(2). Tests were done 60 min after intraperitoneal injection of either vehicle (0.1% lactic acid in saline) or a dose of domperidone (0.1, 0.5, 1.0, or 5.0mg/kg) dissolved in vehicle, each on a separate day. Resting frequency and minute ventilation (mean+/-standard deviation) decreased after domperidone in the BN strain (e.g. 94.63/min+/-4.99 versus 87.37/min+/-9.59, p=0.42; 77.3 ml/min+/-9.25 versus 62.13 ml/min+/-11.5, p=0.019, respectively), but did not change in the SD. With increasing doses of domperidone the ventilatory response to hypoxia and reoxygenation became similar owing to a decrease in frequency and minute ventilation in the SD. At a dose altering SD hypoxic responses, the hypercapnic ventilatory response was not significantly affected. In conclusion, breathing frequency and minute ventilation over a challenge with hypoxia and reoxygenation differ with domperidone depending upon genetic background. We speculate that hypoxic ventilatory responses may be differently configured even among strains of the same species.

Animals↗
PubMed2001

Cardiovascular effects of domperidone in patients with Parkinson's disease treated with apomorphine.

OBJECTIVES: The cardiovascular effects of the peripheral dopamine D2-receptor antagonist domperidone were studied in patients with idiopathic Parkinson's disease treated with continuous subcutaneous infusion of apomorphine. MATERIAL AND METHODS: Blood pressure and heart rate of 10 patients were monitored for 24 h before and after treatment with domperidone using an automatic device for blood pressure recording. RESULTS: Blood pressure and heart rate increased significantly during 24 h of domperidone treatment. When day and night values were analysed separately, a significant difference of blood pressure between the groups was found only during the day whereas heart rate was significantly increased during both day and night. Domperidone shifted blood pressure and heart rate upwards without affecting the drop of blood pressure in the erect position. CONCLUSION: Domperidone increases blood pressure and heart rate without inducing nocturnal hypertension in apomorphine treated patients with idiopathic Parkinson's disease. Increased heart rate by domperidone is a new finding but the clinical significance is unclear and requires further investigation.

Aged↗
PubMed2002

Domperidone is more effective than cisapride in children with diabetic gastroparesis.

BACKGROUND: Disorders of gastrointestinal motility are commonly detected in patients with insulin-dependent diabetes mellitus and are associated with significant morbidity. They contribute to poor metabolic control of diabetes. AIM: To assess the effect of an 8-week course of domperidone or cisapride on gastric electrical activity, gastric emptying time and dyspeptic symptoms in children with insulin-dependent diabetes mellitus and gastroparesis. METHODS: Dyspeptic symptoms were assessed by a score system, gastric emptying time was measured by ultrasonography and gastric electrical activity was obtained by electrogastrography. Fourteen children received domperidone and 14 received cisapride. The median (range) ages were 11.6 years (5-15 years) and 12 years (6-16.9 years), respectively. Symptom assessment, ultrasonography and electrogastrography were repeated at the end of the trial. Fasting and fed (180 min after feeding) glycaemia and haemoglobin A, C (HbA1c) levels were also measured. RESULTS: At the end of the trial both groups showed a significant decrease in symptomatic score; however, the score was markedly lower in the domperidone group than in the cisapride group (P < 0.01). Domperidone was significantly more effective than cisapride in reducing the gastric emptying time (P < 0.05), normalizing gastric electrical activity (P < 0.05) and decreasing the prevalence of episodes of gastric dysrhythmia (P < 0.01). Domperidone was also more effective than cisapride in improving diabetic metabolic control. No potentially drug-related adverse effects occurred. CONCLUSIONS: In children with insulin-dependent diabetes mellitus complicated by dyspeptic symptoms and gastroparesis, domperidone is superior to cisapride in reversing gastric emptying delay and gastric electrical abnormalities, as well as in improving dyspeptic symptoms and diabetic metabolic control.

Adolescent↗
PubMed1993

Domperidone plus paracetamol in the treatment of migraine.

This study was designed to evaluate the safety and efficacy of domperidone in combination with paracetamol in the treatment of migraine. Severity of headache, duration of migraine attack and overall efficacy of treatment were amongst the variables assessed in a randomized, double-blind, three-way cross-over comparison of 1 g paracetamol plus either domperidone 30 mg, domperidone 20 mg or placebo, taken at onset of headache. Forty-six patients attending the City of London Migraine Clinic completed the study. A significant difference was observed in the duration of the migraine attack: a median of 17.5 h with paracetamol alone was reduced to 12.0 h with the addition of domperidone 20 mg, and to 12.0 h with domperidone 30 mg. No significant adverse events were reported. A reduction in pain intensity and nausea was noted but this was not statistically significant. It was concluded that domperidone shortens the duration of a migraine attack and may help reduce headache and associated symptoms.

Acetaminophen↗
PubMed1995

Interaction of the effects of domperidone and sub-anaesthetic concentrations of isoflurane on the immediate and sustained hypoxic ventilatory response in humans.

Twenty normal male subjects with brisk hypoxic ventilatory responses were recruited and ventilatory responses to sustained isocapnic hypoxia (SaO2 80.4 (SD 1.3)% for 20 min) were studied on separate days under four conditions: hypoxia alone, with or without domperidone, and 0.1 MAC of end-tidal isoflurane, with or without domperidone. Ventilatory variables were subjected to analysis of variance with estimation of the effects of isoflurane and domperidone, and their interaction. Isoflurane reduced the initial increase in ventilation significantly by 3.12 (95% confidence limits 1.69, 4.55) litre min-1 (P < 0.05) and domperidone increased the initial increase in ventilation by 1.78 (0.35, 3.21) litre min-1 (P < 0.05). Neither isoflurane nor domperidone affected the subsequent ventilatory decline. No interaction was found between these agents. These results confirm that 0.1 MAC of isoflurane suppressed the initial hypoxic ventilatory response but not the subsequent ventilatory decline when hypoxia was sustained. Domperidone offset the suppressive effect of isoflurane on the hypoxic ventilatory response but no interaction was detected.

Adult↗
PubMed1998

Prophylactic oral antiemetics for preventing postoperative nausea and vomiting: granisetron versus domperidone.

UNLABELLED: In this prospective, randomized, double-blinded study, we evaluated the efficacy of the oral antiemetics, granisetron and domperidone, for the prevention of postoperative nausea and vomiting (PONV) in 100 women undergoing major gynecologic surgery. Patients received either granisetron 2 mg or domperidone 20 mg (n = 50 in each group) orally 1 h before surgery. Standardized anesthetic techniques and postoperative analgesia regimens were used. Complete response (defined as no PONV and no administration of rescue antiemetic medication) for 0-3 h after anesthesia was 88% with granisetron and 52% with domperidone; the corresponding incidence for 3-24 h after anesthesia was 86% and 48% (P < 0.05). No clinically important adverse events due to the drugs were observed in any of the groups. In conclusion, the efficacy of preoperative oral granisetron is superior to that of domperidone for the prevention of PONV after major gynecologic surgery. IMPLICATIONS: We compared the efficacy of granisetron and domperidone administered orally for the prevention of postoperative nausea and vomiting in women undergoing gynecologic surgery. Preoperative oral granisetron was more effective than domperidone.

Administration, Oral↗
PubMed1982

The effects of domperidone on gastric emptying of liquid in man.

1 The effects of domperidone (20 mg) i.v. and saline i.v. on gastric emptying of 500 ml of fluid have been compared in a blind study in six normal male volunteers. 2 Gastric emptying was measured by real-time ultrasound. 3 Domperidone significantly reduced the volume in the stomach 5 min after the drink (domperidone 306 +/- 17 ml, saline 404 +/- 31 ml, P less than 0.02). 4 Domperidone had no significant effect on the half-life of gastric emptying measured between 5 and 60 min (T1/2 domperidone 21.2 +/- 1.17 min, T1/2 saline 21.3 +/- 1.58 min). 5 A similar pattern of gastric emptying to that produced by domperidone could be produced by giving a drink of a smaller volume.

Adult↗
PubMed1991

Interactions between domperidone and ropinirole, a novel dopamine D2-receptor agonist.

1. Ropinirole, SK&F 101468 has been characterized preclinically as a specific dopamine D2-receptor agonist. Nine male healthy subjects were investigated for the effects on supine and erect heart rate and blood pressure, catecholamines and prolactin, of a single dose of 800 micrograms ropinirole preceded by a single dose of 20 mg domperidone or domperidone-placebo, and those of a single dose of domperidone followed by ropinirole-placebo. 2. Single doses of 800 micrograms ropinirole did not cause clinically significant changes in supine resting heart rate and blood pressure. However, they caused postural faintness on 3 min immobile upright standing on 10/26 occasions. 3. Pretreatment with 20 mg domperidone 1 h before administration of ropinirole prevented the postural symptoms in all but one subject. It did not alter ropinirole's plasma pharmacokinetics. 4. Ropinirole did not alter supine or standing catecholamine concentrations. 5. Domperidone increased the plasma concentrations of prolactin whereas ropinirole administered alone reduced them. A single dose of 800 micrograms ropinirole did not attenuate the prolactin increase induced by a single dose of 20 mg domperidone administered 1 h earlier.

Adult↗
PubMed1983

Oral domperidone: double blind comparison with placebo in irritable bowel syndrome.

Symptom scores, stool data, and the transit of a standard, solid meal were measured in 25 patients with irritable bowel syndrome during baseline conditions and after four weeks treatment with placebo and domperidone in the form of a double-blind cross-over trial. All patients had previously undergone a comprehensive series of diagnostic investigations and had failed to respond to dietary supplementation with coarse wheat bran (10-30 g daily). Compared with placebo treatment, domperidone had no significant effect on gastric emptying, small bowel or whole gut transit times, stool weight, frequency, or consistency. Most symptoms improved significantly with both placebo and domperidone treatments, compared with the baseline period, but there was no significant difference between placebo and domperidone for any of the symptoms. Abdominal distension, however, was reported on more days per week during domperidone treatment (p = 0.02). The findings in this study do not support the use of domperidone in the management of irritable bowel syndrome.

Administration, Oral↗
PubMed2005

Comparison of the effects of metoclopramide and domperidone on HERG channels.

Torsades de pointes (TdP) is a potentially fatal form of ventricular arrhythmia that occurs under conditions where cardiac repolarization is delayed (as indicated by prolonged QT intervals from electrocardiographic recordings). A likely mechanism for QT prolongation and TdP is blockade of the rapid component of the cardiac delayed rectifier K(+) current (I(Kr)), which is encoded by HERG (human ether-a-go-go-related gene). The gastroprokinetic agent cisapride is a potent blocker of HERG currents and serious cardiac arrhythmias and deaths from TdP and ventricular fibrillation have been reported in patients taking cisapride. The aim of the present study was to compare the effects of the gastroprokinetic agents domperidone and metoclopramide on HERG channels transiently expressed in human embryonic kidney (HEK 293) cells using the whole-cell configuration of the patch-clamp technique. Both domperidone and metoclopramide concentration-dependently blocked HERG currents, and the following values were calculated for IC(50) (the concentrations causing half-maximal inhibition) and n (the Hill coefficient): 57.0 nmol/l and 0.99 for domperidone, 5.4 micromol/l and 0.95 for metoclopramide. The observation that the extent of block of HERG currents by domperidone increased at more positive membrane potentials whereas block of HERG currents by metoclopramide displayed a smaller degree of voltage dependency seems to indicate that domperidone and metoclopramide have distinct binding sites on HERG channels. In conclusion, the potency for block of HERG currents is about 100-fold lower for metoclopramide when compared to domperidone.

Antiemetics↗
PubMed2006

Pharmacological differences between Liu-Jun-Zi-Tang, a traditional Chinese herbal medicine, and domperidone on isolated guinea-pig ileum.

The different characteristics of Liu-Jun-Zi-Tang, a spray-dried powdered extract from 8 Chinese herbs, and domperidone, a D2 antagonist, both of which are used clinically for the treatment of gastritis, were validated in isolated guinea pig ileal longitudinal muscle. Liu-Jun-Zi-Tang at 0.05 mg/ml did not affect the twitch response by electrical field stimulation, but it concentration-dependently inhibited the twitch response at concentrations of 0.1 and 1.0 mg/ml, and maximum inhibition occurred 5 min after application of Liu-Jun-Zi-Tang. In the presence of Liu-Jun-Zi-Tang, the concentration-response curve for ACh-contraction showed inhibition in a non-competitive manner, which is the same as domperidone. In the presence of Liu-Jun-Zi-Tang (1.0 mg/ml), ACh (10(-7) M)-, histamine (5x10(-7) M)- and barium chloride (10(-4) M)-induced basal contractions were inhibited by 24, 19 and 54 %, respectively. On the other hand, in the presence of domperidone (2x10(-5) M), ACh- and barium chloride-induced basal contractions were inhibited by 28 and 63%, respectively, similar to that in the presence of Liu-Jun-Zi-Tang. However, the inhibition of histamine-induced contraction in the presence of domperidone was significantly increased (81%) compared with that in the presence of Liu-Jun-Zi-Tang. These findings suggest that Liu-Jun-Zi-Tang has milder effects on histamine-induced disorders than domperidone. In other words, domperidone has a more potent effect on histamine-induced disorders.

Acetylcholine↗