Domperidone and long QT syndrome

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Domperidone, a prokinetic agent, is commonly used for gastrointestinal disorders in adults and children.
• Regulatory agencies have issued safety warnings regarding domperidone's association with long QT syndrome.

Purpose of the Study:

• To review literature on domperidone's cardiac risks, including ventricular arrhythmias, sudden cardiac death (SCD), long QT syndrome (LQTS), and Torsade de Pointes (TdP).

Main Methods:

• A literature search was conducted on PubMed from 1966 to January 2010.
• Twenty-two relevant papers were included: in vitro, animal, case reports, clinical studies, and editorials.

Main Results:

• In vitro studies showed domperidone blocks the HERG potassium channel, affecting cardiac repolarization.
• Fourteen cases of cardiotoxicity were identified, primarily with intravenous domperidone.
• A case-control study indicated an increased odds ratio (3.8) for SCD with domperidone exposure.

Conclusions:

• Domperidone administration carries a risk of QT syndrome and associated cardiac events.
• Healthcare providers should assess LQTS risk and avoid co-administration with strong CYP3A4 inhibitors or other QT-prolonging drugs.