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Metoclopramide, domperidone: sudden cardiac death, ventricular arrhythmia

FEATURED REVIEWThe neuroleptics metoclopramide and domperidone have been used since the 1960s and the 1980s respectively for nausea and vomiting. Their limited efficacy and the severity of their adverse effects have slowly come to light over time. Results published in 2015 confirmed and quantified the risks of serious arrhythmia and sudden cardiac death with both drugs.
Full review (3 pages) available for download by subscribers.

Abstract

  • The results of two large epidemiological studies on the association between domperidone and ventricular arrhythmia or sudden cardiac death were published in 2015; one study was conducted in Taiwan and the other in the United Kingdom. They also examined metoclopramide.
     
  • Both studies demonstrated an increased risk of sudden cardiac death and ventricular arrhythmia with metoclopramide, similar to the risk associated with domperidone.
     
  • The results concerning domperidone were consistent with those of previous studies. In particular, they showed that the risk was higher with doses greater than 30 mg per day or with concomitant use of inhibitors of the cytochrome P450 isoenzyme CYP3A4, which reduce domperidone clearance.
     
  • In practice, metoclopramide has a marginal role in patient care, with minor efficacy. Domperidone should not be used at all; its efficacy at the approved dose, beyond a placebo effect, is uncertain.

©Prescrire 1 October 2016

"Metoclopramide, domperidone: sudden cardiac death, ventricular arrhythmia" Prescrire Int 2016; 25 (175): 238-240. (Pdf, subscribers only)
Download the full review.
Pdf, subscribers only

See also:

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

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

Towards better patient care:
drugs to avoid in 2016
Prescrire Int 2016;
25 (170): 105-111.
Pdf, free