Safety of domperidone in treating nausea associated with dihydroergotamine infusion and headache.
OBJECTIVE
To determine the safety of domperidone in the treatment of nausea associated with dihydroergotamine (DHE) infusion and headache.


METHODS
We audited our use of domperidone for the inpatient management of nausea, focusing on known safety concerns, particularly potential cardiac arrhythmias.


RESULTS
We reviewed 103 consecutive admissions of 90 patients admitted for IV DHE by infusion. Most admissions were to treat chronic migraine with (n = 53) or without (n = 46) aura. Domperidone was administered in 85 of 103 encounters and was well-tolerated at doses up to 80 mg/d. A significant side effect, akathisia, was observed in one patient. Baseline ECG with corrected QT interval (QTc) was obtained on all patients. Repeat ECG after domperidone was obtained in 21 patients, whose baseline characteristics did not differ from the group as a whole. ECG was interpreted blindly by a cardiac electrophysiologist. QTc did not differ before and after domperidone administration (Wilcoxon signed-rank test, median [interquartile range] 435.0 [410.5-453.0] at admission and 427.0 [399.0-452.5] after domperidone; p = 0.15). In combination with other antiemetics, domperidone was effective in treating nausea such that no patients had refractory nausea severe enough to limit DHE dose.


CONCLUSIONS
This retrospective audit demonstrates that domperidone is safe in the treatment of nausea associated with inpatient DHE infusion and headache. While larger prospective trials are necessary to confirm these results and assess efficacy, current evidence and clinical experience suggests that domperidone is safe and useful for nausea and headache management.


METHODS
This study provides Class IV evidence that for patients with headache undergoing DHE infusion, domperidone is safe and effective in the treatment of nausea.
From the Department of Neurology (N.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Section of Cardiac Electrophysiology, Division of Cardiology (H.I., M.M.S.), and Department of Neurology (P.J.G.), University of California, San Francisco; and NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK. Nathaniel.M.Robbins@dartmouth.edu.
Nathaniel M
NM
Robbins
From the Department of Neurology (N.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Section of Cardiac Electrophysiology, Division of Cardiology (H.I., M.M.S.), and Department of Neurology (P.J.G.), University of California, San Francisco; and NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK.
Hiroyuki
H
Ito
From the Department of Neurology (N.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Section of Cardiac Electrophysiology, Division of Cardiology (H.I., M.M.S.), and Department of Neurology (P.J.G.), University of California, San Francisco; and NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK.
Melvin M
MM
Scheinman
From the Department of Neurology (N.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Section of Cardiac Electrophysiology, Division of Cardiology (H.I., M.M.S.), and Department of Neurology (P.J.G.), University of California, San Francisco; and NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College London, UK.
Peter J
PJ
Goadsby
D000293:Adolescent; D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004087:Dihydroergotamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004294:Domperidone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
D000932:Antiemetics; D004087:Dihydroergotamine; D004294:Domperidone