Domperidone-induced dystonia: a rare and troublesome complication

Area of Science:

• Neurology
• Pharmacology

Background:

• Domperidone is a widely used antiemetic.
• Extrapyramidal side effects (EPS) are rare complications of domperidone, typically seen in infants due to immature blood-brain barrier.
• The incidence of EPS with domperidone is approximately 1 in 10,000.

Observation:

• A 13-year-old boy developed oromandibular dystonia after four days of treatment with domperidone for viral fever and persistent vomiting.
• The patient received domperidone 30 mg/day in sustained-release form (0.7 mg/kg/day), a recommended dosage.
• Symptoms of dystonia emerged despite the drug being administered at the prescribed dose.

Findings:

• Domperidone administration, even at recommended doses, can induce acute dystonia in children.
• Drug-induced dystonias are generally reversible upon discontinuation of the causative agent.
• The patient's symptoms resolved within 7-8 days after stopping domperidone, with no recurrence at one month follow-up.

Implications:

• This case underscores the potential for domperidone to cause serious neurological side effects like dystonia in pediatric patients.
• Judicious use of domperidone is advised due to the risk of troublesome and potentially life-altering dystonic reactions.
• Awareness of this rare complication is crucial for clinicians prescribing domperidone to children.