Pediatric Domperidone Dosing (Children >12 months)
Domperidone is recommended at 0.25 mg/kg per dose by mouth up to 3 times daily for children (weight <35 kg). [1] The maximum total daily dose is 30 mg/24 hours. [2] The maximum single dose is 10 mg/dose for children <35 kg. [2]
Dosing Regimen and Maximums
- 0.25 mg/kg/dose PO TID (by mouth up to three times daily). [1]
- Maximum single dose: 10 mg/dose (for children/infants <35 kg). [2]
- Maximum daily dose: 30 mg/24 hours (for children/infants <35 kg). [2]
Safety Contraindications: Cardiac and Drug Interaction Risks
Domperidone is contraindicated in patients with severe hepatic impairment. [1] Domperidone is contraindicated in patients with conditions where cardiac conduction is, or could be, impaired and in patients with underlying cardiac disease such as congestive heart failure. [1] Domperidone is contraindicated with QT-prolonging medicines (with specific exceptions per product information). [1] Domperidone is contraindicated with potent CYP3A4 inhibitors (regardless of whether those inhibitors also prolong the QT interval). [1]
Safety Contraindications: Endocrine, GI, and Other Conditions
Domperidone is contraindicated with prolactin-releasing pituitary tumor (prolactinoma). [3] Domperidone is contraindicated with confirmed or suspected pheochromocytoma due to risk of severe hypertension episodes. [3] Domperidone is contraindicated when stimulation of gastric motility could be harmful, including gastrointestinal hemorrhage, mechanical obstruction, or perforation. [3] Domperidone is contraindicated in moderate or severe hepatic impairment. [3] Domperidone is contraindicated in patients with known existing prolongation of cardiac conduction intervals, particularly QTc, significant electrolyte disturbances, bradycardia, or underlying cardiac disease such as congestive heart failure. [3]
Key Safety Warning for Risk-Stratification
Risk of serious cardiac adverse reactions is increased with daily oral doses greater than 30 mg, age >60 years, and concomitant QT-prolonging medicines or CYP3A4 inhibitors. [1]
Practical Limits on Duration of Therapy
Domperidone should be used at the lowest effective dose for the shortest possible duration. [1] The maximum treatment duration should not usually exceed 1 week. [1]
Selection Notes for Pediatric Use
Paediatric dosing is based on bodyweight-adjusted dosing using an accurate measuring device for oral formulations. [1]
Monotherapy vs Combination Therapy Constraints
Domperidone should not be co-administered with QT-prolonging medicines. [1] Domperidone should not be co-administered with potent CYP3A4 inhibitors. [1]