title: Survey of the use of domperidone and the association with QTc prolongation in general practice.
abstract: OBJECTIVE
  Domperidone is associated with QTc prolongation, predisposing to the development of ventricular arrhythmias. In 2014, The Medicines and Healthcare Regulatory Agency (MHRA) recommended restricting its use. We assessed whether these recommendations have been implemented in a general practice.
  
  
  METHODS
  We conducted a prospective study using the general practitioner (GP) computer database on patients who had at least one repeat prescription for domperidone in 12 months. Data were presented to the doctors and the survey was repeated 7 months later.
  
  
  RESULTS
  Sixty-four patients (mean age 61.3±16.4 years) were identified who had received at least one repeat prescription of domperidone. Twenty patients were being prescribed over the recommended daily dose. Nineteen patients were coprescribed medications known to prolong the QTc interval and two CYP3A4 inhibitors. The repeat survey performed 7 months later demonstrated a 70% reduction in the number of patients prescribed domperidone to a total of 19 (three patients prescribed above the recommended dose) none of which had a history of cardiac disease or were being coprescribed drugs known to prolong the QTc interval.
  
  
  CONCLUSIONS
  Following the publication of the MHRA recommendations and presentation of our initial survey, there has been a significant reduction in the number of patients treated with domperidone and those coprescribed drugs known to prolong the QTc interval. We suggest that regular review of GP practice database should be performed to identify those patients prescribed domperidone and at risk of life-threatening arrhythmias and measures taken to use alternative pharmacological agents.
authors.affiliation: University College London, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Ioannou
authors.affiliation: Wrafton House Surgery, Hatfield, UK.
authors.forename: Alka
authors.initials: A
authors.lastname: Jain
authors.affiliation: Ringmead Medical Practice, Birch Hill Medical Centre, Bracknell, UK.
authors.forename: George
authors.initials: G
authors.lastname: Kassianos
authors.affiliation: Cardiology, Frimley Health NHS Foundation Trust, London, UK International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Missouris
mesh_terms: D000368:Aged; D004294:Domperidone / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004562:Electrocardiography; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects; D058006:General Practice / Q000379:methods / Q000592:standards; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008133:Long QT Syndrome / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement; D006113:United Kingdom
chemical_list: D005765:Gastrointestinal Agents; D004294:Domperidone