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Effects of Domperidone on QT Interval in Children with Gastroesophageal Reflux Disease
Thitima Ngoenmak1, Suporn Treepongkaruna2, Yuthapong Buddharaksa3
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; Department of Pediatrics, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand.
Insights
Domperidone use in children under two years old did not significantly prolong the corrected QT interval (QTc). However, two patients on domperidone and lansoprazole experienced QTc increases, suggesting caution with co-administration.
Area of Science:
- Pediatric Cardiology
- Pharmacology
- Gastroenterology
Background:
- Domperidone is frequently prescribed for gastroesophageal reflux disease (GERD) in pediatric patients.
- Limited data exists on domperidone's impact on cardiac repolarization, specifically the corrected QT interval (QTc), in young children.
- This study investigates the effect of domperidone on electrocardiogram (ECG) repolarization parameters in infants and toddlers.
Purpose of the Study:
- To evaluate the short-term effects of oral domperidone on cardiac repolarization in children younger than two years.
- To assess changes in corrected QT interval (QTc) and Tpeak to Tend (TpTe) interval following domperidone administration.
- To determine if domperidone monotherapy necessitates routine ECG monitoring in this age group.
Main Methods:
- Electrocardiograms (ECGs) were obtained from 22 children under two years of age before and after a minimum one-week course of oral domperidone (0.3 mg/kg three times daily).
- Measurements included QT, RR, and Tpeak to Tend (TpTe) intervals to calculate QTc and the TpTe/QT ratio.
- Statistical analysis compared pre- and post-treatment ECG parameters.
Main Results:
- No significant difference was observed in the median QTc interval before and after domperidone treatment (p=0.159).
- Two patients (9.1%) exhibited a QTc interval increase to ≥450 milliseconds, both of whom were receiving concomitant lansoprazole.
- A significant decrease was noted in both the TpTe interval (p=0.001) and the TpTe/QT ratio (p=0.004) after domperidone administration.
Conclusions:
- Short-term domperidone treatment in children under two years does not appear to significantly prolong the QTc interval.
- Concomitant use of domperidone with lansoprazole may be associated with QTc prolongation in susceptible children.
- Routine baseline and follow-up ECGs may not be essential for all children receiving domperidone monotherapy, but caution is advised with combination therapy.
Background:
Domperidone has been widely used in children with gastroesophageal reflux disease (GERD). Studies on the effects of domperidone on corrected QT interval (QTc) in young children are limited. Our aim was to study the effect of domperidone on the repolarization abnormalities assessed by electrocardiogram (ECG) in young children.
Methods:
ECG was performed in children <2 years of age before and after taking domperidone orally 0.3 mg/kg three times/day for at least a 1 week period. Each ECG was reviewed and QT, RR, and Tpeak to Tend intervals (TpTe) were measured to calculate the QTc and TpTe/QT ratio.
Results:
A total of 22 patients (12 male) with a median age of 8.5 months (1-24 months) were enrolled. Most patients (59.1%) were under 1 year of age. The median baseline QTc (410 milliseconds, 350-450 milliseconds) was not significantly different from the QTc after taking domperidone (410 milliseconds, 320-560 milliseconds), p = 0.159. Only two patients showed a QTc increase ≥450 milliseconds. The baseline TpTe interval and TpTe/QT (105 milliseconds, 60-170 milliseconds and 0.27 milliseconds, 0.15-0.43 milliseconds) were significantly greater than the TpTe interval and TpTe/QT in children after taking domperidone (90 milliseconds, 60-140 milliseconds and 0.22 milliseconds, 0.15-0.29 milliseconds), p = 0.001 and 0.004, respectively.
Conclusions:
Our data demonstrate that domperidone treatment over a short-term period in children <2 years of age did not lengthen QTc significantly; however, QTc increased ≥450 milliseconds in two patients with concomitant lansoprazole. Routine baseline and follow-up ECG may not be necessary in each individual case receiving only domperidone.
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