PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Domperidone prolongs oral to duodenal transit time in video capsule
Received: 11 September 2017 / Accepted: 5 December 2017 / Published online: 8 December 2017
Springer-Verlag GmbH Germany, part of Springer Nature 2017
Purpose Domperidone is thought to accelerate gastric emptying via D2 receptor antagonism at the gastro-oesophageal and
gastro-duodenal junctions. Listed in the BNF as a prokinetic anti-emetic, it has been used in video capsule endoscopy (VCE)
to accelerate capsule delivery to the small intestine. We audited VCEs performed at UHCW from 2011, when as standard
practice, domperidone was given pre-VCE, to 2012, after its discontinuation due to doubts about its effectiveness.
Methods Thirty-one patients received oral domperidone 20 mg pre-VCE. Thirty-three patients underwent VCE without
domperidone pre-treatment. After 2 h, if the capsule remained intra-gastric, gastroscopy-assisted duodenal delivery was per-
formed. Data was analysed using Mann-Whitney testing.
Results Median oro-duodenal transit was 13 and 30 min in the untreated and domperidone groups, respectively (p =0.01).
Median oro-caecal transit was 242 and 267 min in the untreated and domperidone groups, respectively (p = 0.02). No difference
in duodenal-caecal transit was seen (p = 0.60). Six percent of untreated and 13% of domperidone VCEs required gastroscopy-
assisted duodenal capsule delivery (p =0.65).
Conclusions Unexpectedly domperidone delayed VCE gastric transit. Most studies on domperidone prokinetic effects have been
in diabetic gastroparesis, demonstrating that domperidone can achieve good symptomatic relief, but with mixed results for gastric
emptying. Our study suggests that any antiemetic effects of domperidone are not mediated through accelerated gastric transit.
Keywords Capsule endoscopy
Domperidone was patented in 1978 by Janssen
Pharmaceuticals after the company discovered that many of
the anti-psychotic drugs they had been developing also had an
antiemetic effect on the chemoreceptor trigger zone.
Domperidone was first marketed in 1982 as an antiemetic for
chemotherapy-induced nausea and vomiting . These proper-
ties are believed to be due to the drugs antagonism of peripheral
dopamine receptors . Its antiemetic properties are believed to
be related to its activity on the D2 receptors in the chemorecep-
tor trigger zone in the postrema and the stomach [3, 4]. It is also
purported to possess prokinetic properties, which are believed
to result from increased oesophageal peristalsis, enhanced gas-
tric peristalsis and antro-duodenal co-ordination via the drugs
action on the dopamine receptors [5, 6].
Currently, domperidone is listed in the British National
Formulary as a prokinetic antiemetic and has been used for
this purpose in clinical practice for several decades .
Despite having been available for many years and being wide-
ly used throughout the world, it has never received a licence
from the Food and Drugs Administration (FDA) in the USA.
This is related to safety concerns over the drug, particularly its
cardiotoxicity . Despite these concerns, it has found wide-
spread use in the treatment of nausea and vomiting in
Parkinsonian patients and in patients with upper gastrointesti-
nal motility disorders, such as a diabetic gastroparesis. Its
preference to other prokinetic drugs such as metoclopramide
owes to its lack of central dopamine antagonism and fewer
side effects .
Video capsule endoscopy (VCE) has come to the fore in
gastroenterology over the last decade as an easy to perform,
minimally invasive test, to investigate the presence of small
* Michael Mcfarlane
Department of Gastroenterology, UHCW, Clifford Bridge Road,
Coventry CV2 2DX, UK
European Journal of Clinical Pharmacology (2018) 74:521–524