title: Ventricular tachyarrhythmia and sudden cardiac death with domperidone use in Parkinson's disease.
abstract: Domperidone is preferentially used over other antiemetic agents to treat digestive symptoms in Parkinson's disease (PD). Concerns have been raised regarding an increased risk of ventricular tachyarrhythmia and sudden cardiac death (VT/SCD) associated with domperidone in the general population. However, the risk in PD is unknown.
  
  
  
  We conducted a multicentre retrospective cohort study using administrative databases from seven Canadian provinces and the UK Clinical Practice Research Datalink. Using a nested case-control analysis, we estimated the rate ratios (RRs) of VT/SCD associated with domperidone use compared to no use in patients newly-diagnosed with PD. VT/SCD events were identified using administrative medical records and vital statistics with a manual review of all potential cases. Meta-analytic methods were used to estimate overall effects across sites.
  
  
  
  Among 214 962 patients with PD, 2907 cases of VT/SCD were identified during 886 581 person-years of follow-up (incidence rate 3.28 per 1000 persons per year). Current use of domperidone was associated with a non-statistically significant 22% increased risk of VT/SCD (RR 1.22; 95% CI 0.99-1.50) compared with no use. The risk was significantly elevated in those with a history of cardiovascular disease (RR 1.38; 95% CI 1.07-1.78), but not in those without (RR 1.21; 95% CI 0.81-1.81). Dose and duration of use did not affect the magnitude of the risk.
  
  
  
  Domperidone use may increase the risk of VT/SCD in patients with PD, particularly those with a history of cardiovascular disease. This risk may be underestimated because of imprecision in identifying VT/SCD events.
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.|Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.|Department of Epidemiology and Biostatistics, McGill University, Montréal, QC, Canada.
authors.forename: Christel
authors.initials: C
authors.lastname: Renoux
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Dell'Aniello
authors.affiliation: Montreal Heart Institute Adult Congenital Center, Université de Montréal, Montréal, QC, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.affiliation: Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital and the Edmond J. Safra Program in Parkinson's Disease Research, University of Toronto, Toronto, ON, Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Marras
authors.affiliation: Faculty of Health Sciences, College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Shawn
authors.initials: S
authors.lastname: Bugden
authors.affiliation: Department of Family Medicine, Cumming School of Medicine, University of Calgary, Health Sciences Centre, Calgary, AB, Canada.
authors.forename: Tanvir Chowdhury
authors.initials: TC
authors.lastname: Turin
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
authors.forename: Lucie
authors.initials: L
authors.lastname: Blais
authors.affiliation: School of Kinesiology and Health Science, York University, Toronto, ON, Canada.|Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
authors.forename: Hala
authors.initials: H
authors.lastname: Tamim
authors.affiliation: College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Charity
authors.initials: C
authors.lastname: Evans
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.|Department of Mathematics and Statistics, McGill University, Montréal, QC, Canada.
authors.forename: Russell
authors.initials: R
authors.lastname: Steele
authors.affiliation: Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: Dormuth
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.|Department of Medicine, Pulmonary Division, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ernst
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects*; D002170:Canada; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D004294:Domperidone / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology; D012189:Retrospective Studies; D012306:Risk; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D000932:Antiemetics; D004294:Domperidone
keywords: Parkinson's disease; domperidone; sudden cardiac death; ventricular arrhythmia