Fewer movement side effects than metoclopramide — but restricted since 2014 over heart rhythm risk.
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Domperidone blocks dopamine receptors in the gut and in the vomiting centre, reducing nausea and speeding up stomach emptying.
Its distinguishing feature is that it barely crosses into the brain. That is genuinely useful: it means it causes far fewer of the movement side effects that limit metoclopramide, which is why it was historically preferred in Parkinson's disease and in younger people.
The problem is the heart. A European safety review in 2014 confirmed a small increased risk of serious ventricular arrhythmia and sudden cardiac death, particularly above 30mg a day, over 60, and alongside certain other drugs. It was restricted to prescription-only at the lowest effective dose for the shortest possible time — usually no more than a week.
Its previous uses have been withdrawn. It is no longer licensed for reflux, bloating, heartburn or long-term dyspepsia — all of which it was once widely used for.
It is still used off-label in specialist settings for gastroparesis, and by specialists in Parkinson's disease where nausea from dopamine agonists is a problem and metoclopramide cannot be used.
Doses above 30mg a day, and use beyond a week, are where the cardiac risk concentrates. The older practice of 20mg three or four times daily is no longer considered acceptable.
Lower doses are used in kidney impairment, and it is avoided in moderate or severe liver impairment.
These occur because domperidone raises prolactin, and they are reversible on stopping.
QT prolongation and serious ventricular arrhythmia. The absolute risk is small, but it is real, and it rises with dose, age over 60, and combination with other QT-prolonging drugs.
Palpitations, fainting, or feeling your heart race or skip while taking it warrant stopping and seeking advice the same day.
Low potassium or magnesium increases the arrhythmia risk, which is worth knowing in anyone on diuretics or with prolonged vomiting.
Not recommended in pregnancy or breastfeeding without advice, though small amounts pass into milk.
An ECG is not routine before short-term use in a healthy young person, but is worth considering in anyone over 60, on multiple medicines, or with cardiac history.
Potassium and magnesium are worth checking in anyone who has been vomiting significantly — which is, awkwardly, the population being treated.
Yes, for short-term nausea and vomiting in someone without cardiac risk factors — and the screening is the substance of the consultation.
What that involves: a careful medicines review looking specifically for QT-prolonging drugs and CYP3A4 inhibitors, age, cardiac history, and any family history of sudden cardiac death or unexplained fainting.
Where it is genuinely the right choice: nausea in someone with Parkinson's disease, where metoclopramide is contraindicated; nausea where movement side effects are a particular concern; and short courses in younger adults with no cardiac risk.
What we will not do: prescribe it above 30mg daily, prescribe it beyond about a week, issue it on repeat, or prescribe it for reflux or bloating — uses for which it is no longer licensed.
What needs urgent in-person assessment: vomiting blood, severe abdominal pain, dehydration, vomiting with severe headache, or persistent vomiting in pregnancy.
This page is information, not an offer to supply.
Domperidone is an inexpensive generic, though it became prescription-only in the UK in 2014 and is no longer available over the counter.
Nausea in Parkinson's disease, or where movement side effects from other antiemetics have been a problem — those are the situations where domperidone does something the alternatives cannot.
Stop after about a week, or as soon as the nausea settles. There is no tapering.
The answer is a diagnosis rather than a longer course. Persistent vomiting needs investigating.
Because of a 2014 European safety review that confirmed a small increased risk of serious heart rhythm problems and sudden cardiac death. It was restricted to the lowest effective dose for the shortest time, and its licences for reflux and bloating were withdrawn.
Domperidone barely enters the brain, so it causes far fewer movement side effects. That is its advantage.
The trade-off is cardiac. Metoclopramide's limit is about movement disorders; domperidone's is about heart rhythm. Which is safer depends entirely on the person taking it.
No — those licences were withdrawn. Reflux is treated with a proton pump inhibitor such as omeprazole or lansoprazole, and it is worth establishing the cause rather than suppressing the symptom.
Domperidone raises prolactin. It is a recognised effect, it happens in both sexes, and it reverses on stopping. Worth reporting rather than enduring.
This is the question that matters most with domperidone. Several common drugs — clarithromycin, erythromycin, some antifungals, some antidepressants and antipsychotics — either prolong the QT interval themselves or raise domperidone levels.
List everything you take, including anything bought over the counter.
With more caution. The cardiac risk is higher over 60, and an alternative is often preferable.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
September 5, 2026
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