The Dilemma with Domperidone

In September of last year, because of safety concerns, the UK decided to change the over-the-counter sale of Domperidone to prescription only. The trade name of this medicine is Motilium, a name we are all more familiar with.

I assumed that Ireland would follow suit. It never happened, and it really puzzled me. It is medicine, with a lot of contraindications and side effects, highlighted across the water; and we fully expected the same thing here, thus taking any responsibility or autonomy from the pharmacists.

My colleagues and I watched with interest, as the Irish Pharmacy Union set about rectifying the situation in the Irish market. We had already shown we could regulate the over-the-counter sale of products containing codeine, and as a result of this campaign, awareness as to the dangers of the addictive drug derived from morphine is at an all time high. That was a real success for Irish Pharmacy.

If we could be trusted with dispensing codeine, we could do the same in this instance: ensuring safe supply of Domperidone. So now, rather than Motilium being available by prescription only, we will administer to customers. We look at their symptoms and make a reasonable assumption whether they need the medicine or not, and we also ensure they are aware of the risks of taking it for any longer than the recommended time or if they exceed the dosage.

By way of a simple explanation as to what the drug does, it is used as a treatment for nausea and vomiting, and as a rule of thumb, when the cause of illness is reasonably apparent. It interferes with the body’s natural digestive rhythm, and speeds the process of food moving through the stomach and bowel.

We go through a set of safety checks before we sell the over-the-counter medicine to a customer.

  1. The sale needs to be made, or at the least, authorised by the Pharmacist on duty
  1. Domperidone should only be sold for the treatment of nausea and vomiting
  1. The maximum daily dose is 30mg- that is, one tablet three times per day
  1. The maximum length of treatment is 7 days
  1. If a person is taking any form of medication related to their heart, it is not appropriate to take Domperidone
  1. If a person is over the age of 60 years, Domperidone should be avoided.

We all have the best of intentions in the workplace, but sometimes when we get stressed or busy, we can miss things. For the sake of vigilance, I have prepared two sets of labels which we place on the Motilium boxes. I have included the photos below, and as you can see, the labels contain the crucial information.

Another system of checks we use in the pharmacy is a software tool called IPUNET. This system is traditionally used to record the likes of Flu vaccinations, but a module for Domperidone has been developed. The idea behind this is to generate statistics used by the Irish Pharmacy Union to show how we regulate the supply of this drug.

It’s extra paperwork of course, and none of us are fond of that, but I will be rigorous in the use of it as part of my own supply procedures from now on. I was really impressed with the module.

So six months or so after the UK decision, a lot of work has been done here to justify keeping the drug as an over-the-counter sale, rather than just by prescription. When the drug is used well, it is very effective.

Thanks to the ongoing stellar work of the Irish Pharmacy Union, we can implement and monitor the rules in a safe and effective way. This works in our favour, as we want to provide a good and convenient service to our own customers. With checks and balances like this in place, we can retain our autonomy as professionals and not become completely over regulated. I can’t wait to argue that point!!


Domperidone label - Conefreys

Domperidone label - Conefreys