Big news from March 2024: the MHRA narrowed domperidone’s recommended use to treating nausea and vomiting only. If you take domperidone or care for someone who does, this change affects when and how it should be used. The update stresses the lowest effective dose for the shortest time and flags people with heart or liver problems as higher risk.
The MHRA review tightened domperidone guidance after safety data linked the drug to rare but serious heart effects, especially when used with other medicines that affect the heart rhythm. The regulator now recommends domperidone only for nausea and vomiting, not for other uses it was sometimes prescribed for. Doctors are asked to use the smallest dose that works and to avoid long-term treatment unless there’s a clear reason and monitoring in place.
Who’s at greater risk? People with known heart disease, prolonged QT on ECG, low potassium or magnesium, liver impairment, and those on drugs that raise domperidone levels. Combining domperidone with strong CYP3A4 inhibitors — for example some antifungals and antibiotics — can increase the chance of heart problems.
If you currently take domperidone, don’t stop it suddenly. Talk to your prescriber first. They’ll check why you’re on it, whether the dose can be lowered, and if a safer alternative fits. Your doctor might order a heart check (an ECG) or review other medicines that can interact.
If you’re prescribed domperidone now, expect these routine steps: a clear reason recorded (nausea/vomiting only), the smallest effective dose, and a plan for how long you’ll use it. If you have heart or liver issues, your clinician should consider avoiding domperidone or monitor you more closely.
What about alternatives? There’s no one-size-fits-all swap. Metoclopramide works for some people but can cause movement side effects. Ondansetron helps chemotherapy or post-op nausea but also affects heart rhythm in certain cases. Non-drug measures—hydration, ginger, small frequent meals, and acupressure—can reduce mild nausea without adding drug risk.
Quick checklist you can use before taking domperidone: 1) Tell your doctor about existing heart or liver disease. 2) List all current medicines, especially antibiotics, antifungals, and some antidepressants. 3) Ask if an ECG is needed. 4) Agree on the shortest effective treatment time. 5) Report new symptoms like palpitations, dizziness, or fainting immediately.
On TrySildenafil this March we published a single clear update summarizing the MHRA guidance and practical tips like these. If you want help making a plan with your clinician, save this page or bring these points to your next appointment.
In a sweeping safety revision, the MHRA has updated the guidelines on domperidone usage, limiting its recommendation to treating nausea and vomiting. The update emphasizes minimal effective dosages and advisories for patients with heart or liver conditions, aiming to mitigate heart-related risks.