The Efficacy of Domperidone in Treating Nausea and Vomiting in Palliative Care

Understanding Domperidone - The Basics

Let us talk about something incredibly important today, and that's palliative care. In many instances, managing nausea and vomiting in palliative care patients can be quite a task. Enter domperidone, a true game-changer. As a mum - to both human and fur kids - I understand how heart-breaking it is when you can do little to alleviate discomfort. My cat, Tabitha, was once quite ill and seeing her suffer truly wounded my heart. So, I can only imagine what it must be like for families with a loved one needing palliative care.

I digress, back to our main hero, domperidone. Domperidone primarily acts as a dopamine antagonist with antiemetic properties. This means it finds nausea and vomiting, where our bodies would be better off without, and shows them the door. I often tell my husband Harrison that if he were a medication, he'd be domperidone - he's great at changing atmospheres for the better.

Choosing Domperidone for Palliative Care

Now, why choose domperidone? This efficient little helper comes with some favourable properties that make it a wonderful choice in a palliative care setting. Domperidone can traverse the brain-blood barrier, reduces the risk of extrapyramidal side effects, and has fewer contraindications than other antiemetics. Just like my Bernese Mountain dog, Rupert, who beats everyone to the door to offer the warmest of welcomes, domperidone is prompt and effective in relieving symptoms, often faster than other medications.

In fact, Rupert and domperidone are more similar than you think. Both are tenacious, reliable and diligent in doing their job. It's another reason why understanding the benefits of domperidone in palliative care makes one feel more hopeful and positive about patient outcomes. We surely could all use more Ruperts and domperidones in our lives.

Dosage and Administration

Dosage, administration and monitoring are crucial when taking any medication, and in the case of domperidone, these factors loom even larger. The common oral dosage is 10 to 20 mg, 3 to 4 times a day, however when administered to palliative care patients, medical professionals take into account numerous factors before finalising the dose. It's much like when I'm cooking for my little girl, Naomi - I adjust the proportions to suit her taste and keep her healthy.

Being diligent with dosage reminds me of our cat Tabitha. Although she seems aloof, she's always doing a routine check and round of the house every day. I imagine these routine checks are like dosages - regular accompaniments, modifying based on observations, for the positive welfare of the household.

Side-Effects: What To Expect

Regrettably, no medication is without its side effects and domperidone isn't an exception either. Some common side effects include dry mouth, headache, nervousness, diarrhoea and rash. But fear not - these side-effects aren't fixed and often vary widely from patient to patient. It’s as unpredictable as Tabitha who licks me out of the blue on certain days.

Despite these adverse effects, the relief provided by the medicine to palliative care patients outweighs the downsides. After all, even a sea has waves that you need to navigate to reach the other side, right?

Comparison with Other Antiemetic Drugs

Domperidone has its advantages, but let's not be unfair: there are other antiemetic drugs that have a great track record too. Metoclopramide and ondansetron, for instance, are commonly used and have proven their efficacy time and again. To clear the air, choosing between these is akin to choosing between Rupert and Tabitha – both are best in their unique ways.

Moreover, the appropriateness of a drug also depends on the patient’s condition and other factors; the right choice would be the one that suits the patient best. It's a lot like ice cream flavors. While I might prefer vanilla, my daughter, Naomi, swears by chocolate. The 'best' flavor ultimately depends on the person enjoying it.

Considerations When Bowing To the Power of Domperidone

Just like any hero has its vulnerability (remember Superman and Kryptonite?), domperidone's effectiveness can also be tempered by factors such as the patient's individual health condition, lifestyle, hereditary predispositions, and more. It’s no magic potion, and like every medication, it's just one part of an overall palliative care plan aimed at increasing comfort and quality of life.

As primary caregivers, or as part of the patient's support system, the aim is to provide our patients with the highest level of comfort and compassion. It’s similar to when Naomi falls sick, I ensure that apart from administering medicines timely, I shower her with lots of love and care to make her feel better.

Conclusion: The All-Rounder We Needed

So to put it simply, domperidone is an effective and safe option for nausea and vomiting in palliative care. It is the diligent star member in the palliative care team. Much like the reliable and comforting presence of my husband, Harrison, in our family, domperidone can fill such a role in palliative care.

Whether you are a caregiver, medical professional or someone who simply stumbled onto this and decided to learn about domperidone, it's important to know this: every bit of information counts. And always remember, every difficult conversation around palliative care is a step towards a more comfortable, understanding, and compassionate future.

8 Comments

Josh Gonzales
Josh Gonzales

September 6, 2023 AT 05:38

Domperidone is solid for palliative nausea but watch the QT interval especially in elderly patients. I've seen cases where even low doses caused arrhythmias if renal function was compromised. Always check electrolytes and baseline ECG. Not as sexy as ondansetron but cheaper and less sedating.

Also, it doesn't cross the BBB much which is why it's safer than metoclopramide for long-term use. Just don't prescribe it to someone on azole antifungals or macrolides.

Jack Riley
Jack Riley

September 7, 2023 AT 09:50

You compare domperidone to a Bernese Mountain dog? That's poetic. But let’s be real - the dog doesn't need a prescription. The dog doesn't have a black box warning. The dog doesn't cost $120 a month at the pharmacy. We romanticize meds like they're furry companions when they're just molecules with agendas.

Tabitha licks you because she's hungry. Domperidone blocks D2 receptors because it's chemically designed to. One is biology. The other is pharmacology. Don't confuse affection with action.

Jacqueline Aslet
Jacqueline Aslet

September 7, 2023 AT 11:36

While the emotional narrative is undeniably poignant, one must question the scientific rigor underpinning this piece. The anthropomorphization of pharmaceutical agents, while aesthetically pleasing, undermines clinical objectivity. Domperidone, as a dopamine antagonist, operates within a strictly defined pharmacokinetic framework. To equate its function with canine loyalty or ice cream preferences is not merely unscientific-it is epistemologically irresponsible.

Furthermore, the absence of cited literature or dosage guidelines based on palliative care guidelines (e.g., EAPC) renders this piece more memoir than medical commentary.

Caroline Marchetta
Caroline Marchetta

September 7, 2023 AT 21:33

Oh sweet mercy, another person comparing drugs to pets.

I’m sure Tabitha the cat would love to know she’s been immortalized as a ‘routine-checking dosage monitor.’ And Harrison? The human domperidone? Wow. What a romantic hero.

Meanwhile, real people are dying from QT prolongation because someone thought ‘it’s like a dog’ so it must be safe.

Stop turning medicine into a Hallmark movie. The side effects aren’t ‘unpredictable like Tabitha.’ They’re documented, quantified, and sometimes fatal. Just say the words: ‘risk-benefit ratio.’

Valérie Siébert
Valérie Siébert

September 8, 2023 AT 11:47

DOMPERIDONE IS A GAME CHANGER FOR PALLIATIVE CARE!! 🙌 I’ve seen it turn a family from panic to peace in 20 mins. No sedation, no confusion, just calm. My aunt was vomiting every hour - 10mg TID and suddenly she was eating soup again. Tears.

Yes it’s off-label in the US but WHO CARES? We’re not in a clinical trial, we’re trying to keep someone from suffering. Give it a shot if they’re not on antifungals or have heart issues. Just talk to the doc. #DomperidoneSavesLives

Kaylee Crosby
Kaylee Crosby

September 9, 2023 AT 20:57

This is such a heartfelt post and I love how you tie medicine to love. Domperidone really is a quiet hero. I work in hospice and we use it all the time - especially when patients can’t swallow pills. The liquid form works wonders.

Just remember to monitor for constipation too. And if the family is overwhelmed, remind them it’s okay to just hold their loved one’s hand while the med does its job. Sometimes comfort isn’t a drug - it’s presence. You’re doing great.

Adesokan Ayodeji
Adesokan Ayodeji

September 10, 2023 AT 22:24

I come from Nigeria where access to many of these drugs is a challenge, but when we get domperidone, it's like finding gold in the dust. In our hospice center, we use it for chemo patients and those with advanced cancer - it works better than metoclopramide because people don't get those stiff limbs or tremors.

My cousin’s mother was vomiting every 30 minutes after radiation. We started domperidone at 10mg three times a day. By day two, she was laughing again, telling stories about her youth. That’s the power of this drug.

Yes, it’s not perfect. Yes, we need more awareness. But don’t let bureaucracy silence hope. If it helps someone eat, sleep, or just stop crying from nausea - it’s worth it. We need more people like you sharing this truth.

Karen Ryan
Karen Ryan

September 12, 2023 AT 13:18

I’m so glad someone finally talked about this without making it a meme 😊. Domperidone is underused in the US because of FDA restrictions, but in Canada and Europe it’s a staple. I’m a nurse and I’ve seen families cry when their loved one can finally keep down broth again.

Also - your cat Tabitha sounds like my rescue, Luna. She checks on me at 3am too. Maybe pets and meds are both quiet guardians. 🐱💊

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