Domperidone – Prescription Only

On Wednesday in the UK it was announced that Domperidone which is sold under the brand name Motilium was being transferred to a prescription-only medicine. This was due to ongoing safety concerns about the drug being available over-the-counter with the possibility of significant heart problems being caused by people either taking too much of it or for longer than recommended.

About two years ago in Ireland Motilium was made a pharmacist-supervised sale and had to be kept out of sight of the customer or in the dispensary. Then about six months ago further restrictions came into force. Domperidone could only be sold for nausea and/or vomiting, the maximum daily dose to be taken is one 10mg tablet three times a day and the maximum duration of use is seven days. Also it was not to be sold to people over 65 years of age or if someone is taking heart medicines. Following Wednesday it will only be a matter of time until Domperidone becomes prescription-only in Pharmacy in the Republic of Ireland.

What to use instead?

So what is left to recommend instead of Motilium? The first products that spring to mind are H2-receptor antagonists, both available without prescription,  such as:

• Ranitidine (Zantac)

• Famotidine (Pepcid AC) 

These drugs work by blocking H2 receptors in the stomach and switching off stomach acid. This would probably be my first port-of-call now for upset stomachs as they work quite quickly. The next group that come to mind are called Proton-pump Inhibitors such as:

• Pantoprazole (Somac, Pantoloc, Gastrolief)

• Omeprazole (Losec Control)

• Nexium Reilef (Esomeprazole) – Soon to be available 

This group work by switching off pumps in the stomach which produce stomach acid.  These are brilliant drugs but take a few days to take full effect so if someone is standing in the shop, has nausea and vomiting as well as other stomach issues H2-receptor antagonists may be a better choice.

Oral rehydration sachets such as Dioralyte would be useful for nausea and vomiting. Dioralyte is a solution of electrolytes which replaces what the body loses when someone is vomiting excessively or has severe diarrhoea. This would be my go-to product now instead of Domperidone as the first one I recommend for nausea and vomiting. 

Motilium -Restriction is imminent

As I write this I’m working on my strategy for an event that has not happened yet but no doubt is imminent. I will update this blog once guidance comes through from the Pharmaceutical Society of Ireland. It is ironic that on Wednesday I was reading a spoof headline about the soft-drink 7-up and it’s impending transfer to prescription-only medicine.  According to an old wives tale (and my late Father) flat 7-up (left out for an hour or so to let the fizz go out of it) is great for sick tummys. Read the article here.

I am sorry that Domperidone is going down the road of further restriction and will miss it as I was very confident recommending Motilium.  The benefits of patient safety must take priority and over the next while hopefully similar, safer products will go the other way from prescription-only to pharmacy only product.  That can only benefit everyone.