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Metopimazine: cardiac disorders

FEATURED REVIEW Metopimazine has received much less attention than domperidone in regard to its cardiovascular adverse effects, but the limited data available suggest that it probably exposes patients to a risk similar to that of domperidone.
Full review (4 pages) available for download by subscribers.


  • Metopimazine, a neuroleptic belonging to the phenothiazine class, is used in France as an antiemetic. It is uncertain whether it has any efficacy beyond a placebo effect in transient nausea and vomiting.
  • Since all neuroleptics carry a risk of arrhythmia through QT prolongation, there are justified concerns over the cardiac harms of metopimazine. Very little published data is available on metopimazine's cardiac adverse effects. 
  • Examination of the French pharmacovigilance database suggests that metopimazine has cardiovascular adverse effects similar to those of domperidone. In late 2016, this database contained 66 reports of cardiovascular adverse effects linked to metopimazine, including 40 cases potentially related to QT prolongation. 
  • In practice, given the absence of more convincing data, in a situation such as gastroenteritis in which the symptoms are minor and resolve spontaneously and drugs have little or no efficacy beyond a placebo effect, avoiding metopimazine and domperidone is a prudent choice.

©Prescrire 1 May 2018

"Metopimazine: cardiac disorders" Prescrire Int 2018; 27 (193): 126-129. (Pdf, subscribers only)

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Download the full review.
Pdf, subscribers only

See also:

Towards better patient care:
drugs to avoid in 2018
Prescrire Int 2018;
27 (192): 107-1 - 107-9.
Pdf, free

Metoclopramide, domperidone:
sudden cardiac death,
ventricular arrhythmia
(October 2016)

Nausea and vomiting: stop
the use of domperidone
once and for all
(February 2014)

Domperidone should not
be used: 9 articles from
Prescrire's ongoing analysis
(February 2014)