title: Domperidone Prescribing Practices Exposed Patients to Cardiac Risk despite a "Black Box" Warning: A Canadian Tertiary Care Center Study.
abstract: Background. In 2012, Health Canada released a warning regarding domperidone use, based on associations with life-threatening arrhythmias and death. Objective. This study aimed to compare the appropriateness of domperidone prescribing patterns before the advisory to those afterward. Methods. Two retrospective reviews were conducted for patients prescribed domperidone during quarters in 2005 and 2012. Outcomes included appropriateness of indication, dosing regimens, monitoring of electrolytes, baseline electrocardiogram performance and characteristics, presence of left ventricular dysfunction, and coprescription of QT-prolonging medications. Univariable and multivariable logistic regression analyses were performed. p values < 0.05 were considered significant. Results. 290 and 287 patients were analyzed in 2005 and 2012, respectively. Domperidone initiation in hospital decreased from 2005 to 2012 (71.4% versus 39.4%, p < 0.0001) as did prescriptions for nonapproved indications (84.8% versus 58.2%, p < 0.0001). In-hospital initiation predicted prescription for nonapproved indications (OR = 7.01, 95% CI 4.52-10.87, p < 0.0001). Use of domperidone as the sole GI drug predicted nonapproved indications (OR = 2.51, 95% CI 1.38-4.55, p = 0.002). Conclusions. The advisory was associated with more appropriate domperidone initiation and compliance with recommended dosages. Our study suggests the need for increased awareness of the dosing and monitoring of domperidone to ensure patient safety.
authors.affiliation: Division of Gastroenterology, McMaster University Department of Medicine, Hamilton, ON, Canada L8S 4K1; Division of Gastroenterology, University of Calgary Therapeutic Endoscopy Training Program, Calgary, AB, Canada T2N 4Z6.
authors.forename: Nauzer
authors.initials: N
authors.lastname: Forbes
authors.affiliation: Division of Gastroenterology, McMaster University Department of Medicine, Hamilton, ON, Canada L8S 4K1.
authors.forename: Mohan
authors.initials: M
authors.lastname: Cooray
authors.affiliation: Division of Gastroenterology, McMaster University Department of Medicine, Hamilton, ON, Canada L8S 4K1.
authors.forename: Raed
authors.initials: R
authors.lastname: Al-Dabbagh
authors.affiliation: Farncombe Family Digestive Research Institute, Hamilton, ON, Canada L8S 4K1.
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Division of Gastroenterology, McMaster University Department of Medicine, Hamilton, ON, Canada L8S 4K1.
authors.forename: Frances
authors.initials: F
authors.lastname: Tse
authors.affiliation: Division of Gastroenterology, University of Toronto Department of Medicine, Toronto, ON, Canada M5T 2S8.
authors.forename: Louis W C
authors.initials: LW
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology, McMaster University Department of Medicine, Hamilton, ON, Canada L8S 4K1.
authors.forename: Ted
authors.initials: T
authors.lastname: Xenodemetropoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D004294:Domperidone / Q000008:administration & dosage / Q000009:adverse effects*; D004348:Drug Labeling / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056687:Off-Label Use / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000932:Antiemetics; D004294:Domperidone