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Motilium (Generic)

Motilium (domperidone) is a medicine that increases the movements or contractions of the stomach and bowel. Domperidone is also used to treat nausea and vomiting caused by other drugs used to treat Parkinson's Disease.


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Uses

Domperidone is indicated for:
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Delayed gastric emptying of functional origin with gastro-oesophageal reflux and/or dyspepsia.

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Control of nausea and vomiting of central or local origin.

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As an anti-emetic in patients receiving cytostatic and radiation therapy.

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Facilitates radiological examination of the upper gastro-intestinal tract.

How to take

Acute conditions (mainly nausea, vomiting, hiccup)
Adults: Two tablets (20 mg) 3 to 4 times per day, 15 to 30 minutes before meals and, if necessary, before retiring.
Children 5 to 12years old: One tablet (10mg) 3 to 4 times per day, 15 to 30minutes before meals and, if necessary, before retiring.
Chronic conditions (mainly dyspepsia)
Adults: One tablet (10 mg) taken 3 times per day, 15 to 30 minutes before meals and, if necessary, before retiring. The dosage may be doubled.
Children 5 to 12years old: ½tablet (5mg) 3to 4times per day, 15to 30minutes before meals and if necessary, before retiring.
This formulation is not suited for children under the age of 5years, but for this group of patients the suspension is available.

Side effects

Allergic reactions, such as rash or urticaria, have been reported.
Abdominal cramps have been reported.
Dystonic reactions (extra pyramidal phenomena) may occur.
Reversible raised serum prolactin levels have been observed which may lead to galactorrhoea and gynaecomastia.
Hypertensive crises in patients with phaeochromocytoma may occur with administration of domperidone.
Where the blood brain barrier is not fully developed (mainly in young babies) or is impaired, the possible occurrence of neurological side-effects cannot be totally excluded

Precaution

Since domperidone is highly metabolised in the liver, domperidone should be used with caution in patients with hepatic impairment (and in the elderly).
Domperidone should be used with caution in patients with renal impairment or in those at risk of fluid retention. In patients with severe renal insufficiency (serum creatinine more than 6mg/100ml, i.e. more than 0,6mmol/L) the elimination half-life of domperidone was increased from 7,4 to 20,8 hours. The dosing frequency should be reduced to once or twice daily, depending on the severity of impairment, and the dose may need to be reduced. Patients on prolonged therapy should be reviewed regularly

Drug interactions

Concomitant administration of anti-cholinergic drugs may inhibit the anti-dyspeptic effects of domperidone.
Anti-muscarinic agents and opioid analgesics may antagonize the effect of domperidone.
Domperidone suppresses the peripheral effects (digestive disorders, nausea and vomiting) of dopaminergic agonists.
Since domperidone has gastro-kinetic effects, it could influence the absorption of concomitant orally administered medicines, particularly those with sustained release or enteric coated formulations.
As domperidone interferes with serum prolactin levels, it may interfere with other hypoprolactinaemic agents and with some diagnostic tests.
Antacids and anti-secretory agents lower the oral bioavailability of domperidone. They should be taken after meals and not before meals, i.e. they should not be taken simultaneously with domperidone.
Reduced gastric acidity impairs the absorption of domperidone.
Oral bioavailability is decreased by prior administration of cimetidine or sodium bicarbonate.
The main metabolic pathway of domperidone is through CYP3A4. In vitro data suggests that concomitant use of drugs that significantly inhibit this enzyme may result in increased plasma levels of domperidone. Examples of CYP3A4 inhibitors include the following:
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azole antifungals
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macrolide antibiotics
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HIV protease inhibitors
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nefazodone

Missed dose

If you miss a dose, take as soon as remembered; do not take if it is almost time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

Storage

Store below 25 degrees away from moisture and sunlight. Do not store in the bathroom. Keep away from children and pets.