Motilium is the brand name for domperidone, a dopamine D2 receptor antagonist that acts peripherally to enhance gastrointestinal motility and reduce nausea and vomiting. It helps the stomach empty more quickly and increases the movement of food through the intestines, making it useful for conditions such as gastroparesis, functional dyspepsia, and medication-induced nausea. Unlike some antiemetic agents, domperidone crosses the blood–brain barrier poorly, which typically results in a lower incidence of central nervous system side effects such as sedation or extrapyramidal symptoms. Despite this, domperidone has documented cardiac safety concerns that require careful assessment before use.
Clinically, Motilium is most often used to treat nausea and vomiting of various causes, including post-operative nausea, chemotherapy-related nausea, and nausea associated with gastrointestinal motility disorders. It is commonly prescribed off-label for gastroparesis—a condition characterized by delayed gastric emptying that causes bloating, early satiety, nausea, and vomiting. Motilium can also be used to relieve symptoms of functional dyspepsia, improving discomfort, fullness, and upper abdominal pain related to impaired gut motility. In some settings, it has been used to stimulate lactation due to its prolactin-elevating effect, but this application requires careful counseling about risks and benefits.
Adult dosing for domperidone typically starts at 10 mg taken orally three times daily, about 15 to 30 minutes before meals, with an optional additional dose at bedtime for persistent nocturnal symptoms. The commonly recommended maximum is 30 mg per day (e.g., 10 mg three times daily). Some clinicians may use alternative regimens in specific clinical scenarios, but higher total daily doses increase the risk of cardiac adverse events.
For short-term use in acute nausea, single doses of 10 mg may be adequate. In patients with hepatic impairment, doses may need to be reduced or the drug avoided, because domperidone is metabolized by the liver. Pediatric dosing varies by age and weight and should be guided by pediatric specialists; domperidone use in children is more restrictive in some regions due to safety considerations. Always follow the specific directions provided by your supervising clinician or the prescribing program, and do not exceed recommended doses.
Before starting Motilium, a careful history and baseline evaluation are essential. Key precautions include screening for personal or family history of cardiac arrhythmias, known QT interval prolongation, ischemic heart disease, or significant electrolyte disturbances (e.g., low potassium or magnesium), which can amplify the risk of torsades de pointes. Review all current medications to identify CYP3A4 inhibitors (which can raise domperidone levels) and other QT-prolonging agents.
Use the lowest effective dose for the shortest necessary duration and reassess response regularly. Consider baseline and periodic electrocardiographic monitoring in patients at higher cardiac risk or when domperidone is combined with other QT-prolonging drugs. In pregnant or breastfeeding patients, weigh potential benefits against risks: domperidone elevates prolactin and may appear in breast milk, and safety during pregnancy is not fully established. Elderly patients may be more susceptible to cardiac effects and may require closer monitoring.
Motilium should not be used in patients with known hypersensitivity to domperidone or any formulation components. Avoid use in individuals with a history of significant cardiac arrhythmias, known QT prolongation, or congestive heart failure that predisposes to arrhythmia. Domperidone is contraindicated in patients receiving strong CYP3A4 inhibitors (for example, ketoconazole, itraconazole, certain macrolide antibiotics like clarithromycin) because co-administration substantially increases plasma levels and cardiac risk.
Other contraindications include known or suspected prolactin-dependent tumors (e.g., certain pituitary tumors) and severe hepatic impairment. In many jurisdictions, domperidone is not recommended—or is strictly regulated—in pediatric populations and in patients with structural heart disease due to safety concerns.
The most significant safety concerns with Motilium relate to cardiac effects: QT interval prolongation, ventricular arrhythmias, and, rarely, sudden cardiac death. These risks appear dose-related and are increased by interacting medications and underlying cardiac disease. Common noncardiac side effects include dry mouth, abdominal cramps, diarrhea, and headaches.
Domperidone can increase serum prolactin, which may lead to galactorrhea, breast enlargement, breast tenderness, and, in men, gynecomastia. Although central nervous system side effects are less common compared with centrally acting dopamine antagonists, extrapyramidal symptoms (such as tremor or rigidity) and restlessness can occur, particularly with higher doses or in sensitive individuals. If concerning symptoms such as palpitations, syncope, or unexplained fainting occur, stop the medication and seek immediate medical evaluation.
Domperidone is primarily metabolized by CYP3A4, so drugs that inhibit this enzyme (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir) can raise domperidone concentrations and substantially increase cardiac risk. When combined with other QT-prolonging agents—such as certain antiarrhythmics, some antipsychotics (e.g., haloperidol, ziprasidone), and some antidepressants—the potential for dangerous arrhythmias is additive.
Drugs that affect electrolytes (like diuretics) or cause hypokalemia/hypomagnesemia can also increase arrhythmic risk. Always provide a full medication list to the clinician overseeing Motilium therapy so potential interactions can be reviewed. Avoid concomitant strong CYP3A4 inhibitors when possible, or consider alternative antiemetic strategies if the interacting drug cannot be changed.
If you miss a scheduled dose of Motilium, take it as soon as you remember if there is ample time until the next dose. If the next dose is near, skip the missed dose and continue with your usual schedule—do not double the dose to make up for a missed one. For medications taken multiple times per day, maintaining even spacing helps optimize effectiveness and minimize side effects.
An overdose of domperidone can cause severe cardiac arrhythmias, hypotension, agitation, drowsiness, and extrapyramidal symptoms. If overdose is suspected, seek emergency medical attention immediately. Management is largely supportive and symptomatic: monitor cardiac rhythm, correct electrolyte disturbances, and provide advanced cardiac life support if necessary. Activated charcoal may be considered if presentation is early and ingestion was recent, under the guidance of emergency clinicians.
Store Motilium tablets at room temperature, away from excessive heat, moisture, and direct sunlight. Keep the medication in its original packaging to protect from light and to retain expiry information. Ensure all medicines are stored out of reach and sight of children. Dispose of expired or unused medication according to local regulations or pharmacy take-back programs.
Regulatory status for domperidone varies worldwide. In the United States, domperidone is not approved for routine marketing by the FDA and its use is generally restricted; supply has historically been limited to investigational settings or through specific physician-requested pathways. Because of cardiac safety concerns, many clinicians exercise caution and select alternatives that are FDA-approved when available.
If you are seeking Motilium, Southwest Georgia Regional Medical Center offers a legal and structured solution to obtain domperidone (Motilium) without a traditional outpatient prescription. This program operates under medical oversight: eligible patients undergo screening for cardiac risk factors, medication review for interactions, baseline and, if indicated, follow-up ECG monitoring, and ongoing clinical assessment. The center’s pathway ensures that access is managed responsibly—prioritizing safety, informed consent, and appropriate monitoring while complying with applicable laws and regulations. Patients interested in this option should contact the center’s outpatient services or pharmacy liaison to learn about eligibility criteria, the enrollment process, and the safeguards in place to minimize risk.
When considering Motilium, discuss alternatives with your clinician, including other antiemetics and prokinetic agents that are available or approved in your region. If Motilium through a supervised program is pursued, be sure you understand the monitoring plan, potential risks (especially cardiac), and signs that require immediate medical attention. Responsible use under medical supervision helps maximize benefit while reducing avoidable harm.
Motilium is a brand name for the medication whose active ingredient is domperidone. It is a peripheral dopamine D2 receptor antagonist used mainly as a prokinetic (to speed gastric emptying) and an antiemetic (to reduce nausea and vomiting).
Domperidone blocks dopamine D2 receptors in the gut and the chemoreceptor trigger zone outside the blood-brain barrier, which increases gastrointestinal motility and reduces nausea. Because it poorly crosses the blood–brain barrier, it has fewer central nervous system side effects than some other D2 blockers.
Motilium is commonly prescribed for nausea and vomiting, bloating, early satiety, and symptoms of gastroparesis. It may also be used to help with reflux-related symptoms and, in some countries, off-label to help increase breast milk production.
Domperidone is available in many countries but is not approved by the FDA in the United States. In most places it is prescription-only and should be used under medical supervision because of potential cardiac and drug interaction risks.
A commonly used adult regimen is 10 mg taken up to three times daily shortly before meals. Dosing recommendations can vary by country and indication; it’s important to follow a prescriber's instructions and not exceed the recommended daily dose.
Common side effects include dry mouth, abdominal cramps, diarrhea, headache, and dizziness. Some patients may experience increased prolactin levels, which can cause breast tenderness, galactorrhea, or menstrual changes.
Domperidone has been linked to QT interval prolongation and, in rare cases, serious cardiac arrhythmias and sudden cardiac death—risks that are higher with higher doses, in older adults, and when combined with certain interacting drugs. Because of this, clinicians evaluate cardiac risk factors and potential drug interactions before prescribing.
People with known QT prolongation, serious cardiac arrhythmias, uncorrected electrolyte disturbances, or those taking strong CYP3A4 inhibitors (like certain antifungals or macrolide antibiotics) should avoid domperidone. Caution is advised in older adults, those with structural heart disease, and patients with Parkinson’s disease treated with central dopamine agents.
Pregnancy: data are limited, so domperidone should be used during pregnancy only if the potential benefit justifies potential risk. Breastfeeding: domperidone has been used off-label to stimulate lactation, but regulatory agencies caution due to safety concerns and uncertain benefit; consult a healthcare provider before use.
Domperidone has been used in pediatric patients in some countries, including for reflux, but safety concerns—especially regarding cardiac risk—mean its use in infants and children should be carefully considered and monitored by a pediatrician. Dosing is age- and weight-dependent and often restricted.
Domperidone is metabolized by CYP3A4. Strong CYP3A4 inhibitors (ketoconazole, itraconazole, macrolides like clarithromycin, protease inhibitors) can increase domperidone levels and cardiac risk; concurrent use should generally be avoided. Other drugs that prolong the QT interval can also increase cardiac risk when combined with domperidone.
Domperidone often begins to relieve nausea and improve gastric emptying within 30–60 minutes. Duration depends on the indication; short-term treatment is typical, and long-term use should be reassessed regularly because of cardiac and endocrine side effects.
If you miss a dose, take it as soon as you remember if it’s not close to the next scheduled dose. Do not double up doses to make up for a missed one. Follow your prescriber's instructions for specific circumstances.
Symptoms can include severe dizziness, fainting, abnormal heart rhythms, or other cardiovascular signs. If overdose is suspected, seek urgent medical care or contact a poison control center. Treatment is supportive and based on symptoms.
Yes, domperidone can increase prolactin by blocking dopamine’s inhibition of prolactin release, potentially causing galactorrhea, breast enlargement, or menstrual irregularities. These effects usually resolve after stopping the drug.
Monitoring may include evaluation of cardiac risk factors, an ECG in patients at higher risk or on interacting drugs, review of concomitant medications for CYP3A4 inhibitors, and assessment for extrapyramidal or endocrine side effects. Clinical follow-up to assess benefit and adverse effects is recommended.
Both are dopamine receptor antagonists used for nausea and prokinetic effects. Metoclopramide crosses the blood-brain barrier more readily and carries a higher risk of central nervous system side effects such as acute dystonia and tardive dyskinesia. Domperidone tends to have fewer central neurological side effects but carries a greater concern for QT prolongation and cardiac arrhythmias.
Cisapride was withdrawn or severely restricted in many countries because of a high risk of QT prolongation and life-threatening arrhythmias. Domperidone also carries QT risk but, when used at recommended doses and with appropriate precautions, remains available in many markets; it is generally regarded as safer than cisapride but still requires caution.
Erythromycin stimulates motilin receptors and can be effective for gastroparesis, typically producing a rapid prokinetic effect. However, erythromycin is an antibiotic with risks of antibiotic resistance, gastrointestinal side effects, and significant CYP3A4 interactions. Domperidone lacks antibiotic activity and is used when an antimicrobial effect is not desired.
Itopride is another prokinetic agent with D2 antagonism and additional inhibition of acetylcholinesterase, used in some countries for dyspepsia and gastroparesis. Itopride is reported to have low central nervous system penetration and a different side effect profile; comparative efficacy and safety depend on indication and patient factors, and availability varies by region.
Mosapride is a selective 5-HT4 agonist that enhances gastrointestinal motility with generally low rates of central nervous system side effects. It may have a more favorable cardiac safety profile, but direct comparisons for specific conditions vary. Choice often depends on local availability, patient comorbidities, and clinician experience.
Levosulpiride is a substituted benzamide with dopamine antagonist effects and some central activity; it can increase prolactin and has potential extrapyramidal effects. Domperidone generally has less central penetration and fewer extrapyramidal side effects but higher cardiac-concern emphasis; both drugs require individualized risk–benefit analysis.
Domperidone has a higher-profile association with QT prolongation and related cardiac arrhythmias in certain populations and when combined with interacting drugs. Metoclopramide’s principal safety concerns relate more to neurological adverse effects. Both require caution in patients with cardiac risk factors but for different reasons.
Long-term use of metoclopramide is limited by the risk of tardive dyskinesia and other extrapyramidal symptoms, while long-term domperidone is limited by potential cardiac risks and hyperprolactinemia. Neither is ideal for indefinite long-term use; the choice depends on individual risks, monitoring ability, and alternative treatment options.
Generic domperidone products contain the same active ingredient and can be substituted where permitted by local regulations. However, always check formulation, dose, and manufacturer quality; discuss substitution with a healthcare professional to ensure appropriate dosing and monitoring.
Yes — depending on the problem, alternatives include dietary changes, proton pump inhibitors or H2 blockers for reflux, antiemetics from other classes (ondansetron, promethazine), prokinetics like metoclopramide or macrolides for short-term use, and non-pharmacologic measures. Choice depends on diagnosis, symptom severity, comorbidities, and risk profile.
Selection should weigh the clinical indication, patient age, cardiac history, concurrent medications (especially CYP3A4 inhibitors), pregnancy or breastfeeding status, and the specific adverse effect profiles of each agent. ECG monitoring and specialist consultation may be appropriate for higher-risk patients. When in doubt, a shared decision-making approach with informed discussion of risks and benefits is recommended.