Motilium

Motilium (domperidone) is a dopamine antagonist medication specifically designed to address upper gastrointestinal motility issues. It is widely prescribed by healthcare professionals to manage symptoms such as nausea, vomiting, bloating, and discomfort associated with delayed gastric emptying. By enhancing gastric peristalsis and improving coordination between the stomach and duodenum, Motilium facilitates more efficient digestion and provides symptomatic relief for a range of gastrointestinal disorders. Its mechanism of action focuses on the chemoreceptor trigger zone and the gastrointestinal tract, making it a targeted therapeutic option for patients experiencing functional dyspepsia, gastroparesis, or reflux-related symptoms.

Features

• Active ingredient: Domperidone 10mg per tablet
• Form: Oral tablets, dispersible tablets, and suspension
• Mechanism: Peripheral dopamine D₂ and D₃ receptor antagonist
• Onset of action: Approximately 30–60 minutes after administration
• Half-life: 7–9 hours in most patients
• Excretion: Primarily hepatic metabolism with fecal elimination

Benefits

• Effectively reduces episodes of nausea and vomiting by blocking dopamine receptors in the chemoreceptor trigger zone
• Accelerates gastric emptying and improves gastroduodenal coordination, relieving postprandial fullness and bloating
• Minimizes symptoms of gastroesophageal reflux by increasing lower esophageal sphincter tone
• Provides well-tolerated symptomatic relief for chronic conditions like diabetic gastroparesis and functional dyspepsia
• Does not readily cross the blood-brain barrier, reducing risk of extrapyramidal side effects compared to central antiemetics
• Available in multiple formulations to suit different patient needs and preferences

Common use

Motilium is commonly prescribed for the management of nausea and vomiting of various etiologies, including that associated with migraine, medication side effects, or functional gastrointestinal disorders. It is particularly useful in cases of delayed gastric emptying (gastroparesis) often seen in diabetic patients, as well as for symptomatic relief in functional dyspepsia characterized by early satiety, postprandial fullness, and upper abdominal discomfort. Additionally, it may be used off-label to stimulate lactation in breastfeeding women, though this application requires careful medical supervision due to potential cardiac risks.

Dosage and direction

The standard adult dosage is 10-20mg (1-2 tablets) taken three to four times daily, preferably 15-30 minutes before meals and at bedtime. Maximum daily dosage should not exceed 30mg for most patients, or 10mg three times daily in those with hepatic impairment. Tablets should be swallowed whole with water, though dispersible formulations may be placed on the tongue for rapid dissolution. Treatment duration should be limited to the shortest period necessary for symptom control, typically not exceeding one week for acute nausea and vomiting. For chronic conditions, periodic re-evaluation of continued therapy is recommended.

Precautions

Patients with hepatic impairment require dosage reduction and careful monitoring due to reduced domperidone metabolism. Electrolyte imbalances (particularly hypokalemia and hypomagnesemia) should be corrected before initiation, as they may increase the risk of QT prolongation. Use with caution in patients over 60 years of age due to increased susceptibility to cardiac adverse effects. Breastfeeding women should use only under direct medical supervision, weighing potential benefits against risks. Patients should be monitored for signs of hyperprolactinemia, including galactorrhea, gynecomastia, or menstrual irregularities.

Contraindications

Motilium is contraindicated in patients with known hypersensitivity to domperidone or any excipients in the formulation. It must not be used in individuals with pre-existing QT prolongation or known congenital long QT syndrome. Concomitant use with QT-prolonging drugs is absolutely contraindicated. Severe hepatic impairment (Child-Pugh Class C) prohibits use due to significantly reduced clearance. Patients with prolactinoma or known gastrointestinal obstruction, perforation, or hemorrhage should not receive Motilium. Concomitant strong CYP3A4 inhibitors are contraindicated due to dramatically increased domperidone exposure.

Possible side effect

The most commonly reported adverse effects include headache (approximately 2-4% of patients), dry mouth (1-2%), and gastrointestinal disturbances such as diarrhea or abdominal cramps (1-3%). Hyperprolactinemia may occur, potentially leading to galactorrhea, breast enlargement, or menstrual irregularities. Less frequently, allergic reactions including rash, pruritus, or urticaria have been reported. Cardiac effects, while rare, may include QT interval prolongation, ventricular arrhythmias, or sudden cardiac death, particularly at higher doses or in susceptible populations. Extrapyramidal symptoms are uncommon due to poor blood-brain barrier penetration but may occur in sensitive individuals.

Drug interaction

Concomitant use with strong CYP3A4 inhibitors (ketoconazole, fluconazole, clarithromycin, ritonavir) is contraindicated due to dramatically increased domperidone levels. Moderate CYP3A4 inhibitors (erythromycin, verapamil, diltiazem) require careful monitoring and potential dosage adjustment. Drugs that prolong QT interval (antiarrhythmics, certain antidepressants, antipsychotics) should be avoided. Anticholinergic medications may antagonize Motilium’s prokinetic effects. Dopamine agonists (bromocriptine, levodopa) may have reduced efficacy when co-administered. Gastric pH modifiers (antacids, H2 blockers, PPIs) do not significantly affect absorption but may be taken separately if concerned about theoretical interactions.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. For patients using Motilium on an as-needed basis for nausea, take when symptoms occur rather than on a fixed schedule. Maintain at least 4-6 hours between doses to prevent accumulation and potential side effects.

Overdose

Symptoms of overdose may include agitation, confusion, seizures, extrapyramidal reactions, and QT prolongation with potential arrhythmias. There is no specific antidote for domperidone overdose. Management consists of gastric lavage if presentation is early, followed by activated charcoal administration. Cardiac monitoring for at least 24 hours is essential, with particular attention to QT interval. Symptomatic treatment for extrapyramidal symptoms may include anticholinergic agents such as benztropine. Supportive care including electrolyte correction and maintenance of vital functions forms the mainstay of management. Hemodialysis is not effective due to high protein binding.

Storage

Store at room temperature (15-30°C) in the original container, protected from light and moisture. Keep blister strips sealed until immediately before use. Do not transfer tablets to alternative containers that lack proper moisture protection. Keep out of reach of children and pets. Do not use beyond the expiration date printed on packaging. For suspension formulations, shake well before use and discard any unused portion after the recommended period (typically 14 days after reconstitution). Do not freeze liquid formulations.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Motilium is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to therapy may vary, and proper diagnosis should precede treatment initiation. Patients should discuss their complete medical history, including all medications and supplements, with their prescribing physician. This document does not replace the official prescribing information and should be used in conjunction with professional medical guidance.

Reviews

Clinical studies demonstrate Motilium’s efficacy in multiple gastrointestinal disorders. A meta-analysis of 26 randomized controlled trials involving over 2,800 patients with functional dyspepsia showed significant improvement in global symptoms compared to placebo (RR 0.71, 95% CI 0.61-0.83). For diabetic gastroparesis, domperidone demonstrated superior symptom control versus metoclopramide with better neurological safety profile. Systematic reviews confirm its effectiveness in chemotherapy-induced nausea when combined with standard antiemetics. Post-marketing surveillance data indicate generally favorable tolerability, though cardiac monitoring remains recommended, particularly in higher-risk populations. Patient-reported outcomes consistently show improvement in quality of life measures related to gastrointestinal symptom burden.