Emetrol (domperidone) is a dopamine antagonist with antiemetic properties. Domperidone slightly penetrates through the blood-brain barrier. The use of emetrol (domperidone) is rarely accompanied by extrapyramidal side effects, especially in adults, but Domperidone stimulates prolactin release from the pituitary gland. Its antiemetic effect may be due to a combination of peripheral (gastrokinetic) action and antagonism to dopamine receptors in the chemoreceptor trigger zone, which is outside the blood-brain barrier in the posterior area (area postrema). Animal studies, as well as the low concentrations found in the brain, indicate a predominantly peripheral effect of domperidone on dopamine receptors. Studies in humans have shown that when taken orally, Emetrol increases pressure in the lower esophagus, improves antroduodenal motility and accelerates gastric emptying. Domperidone has no effect on gastric secretion.
Symptoms. Symptoms of overdose may include agitation, impaired consciousness, seizures, somnolence, disorientation and extrapyramidal reactions, especially in children.
Treatment. There is no specific antidote for domperidone, but in case of a significant overdose, gastric lavage within 1 hour after taking the drug and use of activated charcoal is recommended, as well as close monitoring of the patient and supportive therapy. Anticholinergic drugs, Parkinson’s disease agents may be effective in controlling extrapyramidal reactions.
Subject to compliance with the recommendations for the dosage and duration of treatment, domperidone is usually well tolerated and adverse reactions are infrequent.
Immune system disorders: allergic reactions, including anaphylaxis, anaphylactic shock, hypersensitivity.
Endocrine system: increase in prolactin levels.
Mental disorders: nervousness, irritability, agitation, depression, anxiety, decreased or absent libido.
Nervous system disorders: extrapyramidal disorders, insomnia, dizziness, thirst, seizures, lethargy, headache, somnolence, akathisia.
Cardiovascular system: edema, palpitation, disorders of heart rate and rhythm, prolongation of the QT interval (frequency is unknown), serious gastric arrhythmias, ventricular arrhythmia (type “torsade de pointes”), sudden cardiac death.
Gastrointestinal tract: dry mouth, transient intestinal cramps, diarrhea, gastrointestinal disorders, including abdominal pain, regurgitation, changes in appetite, nausea, heartburn, constipation.
Organs of vision: oculogyric crises.
Skin and subcutaneous tissue: itching, rash, urticaria, angioedema.
Reproductive system and mammary glands: galactorrhea, breast enlargement / gynecomastia, breast sensitivity, breast discharge, amenorrhea, breast swelling, pain in the breast area, lactation disorders, irregular menstrual cycle.
Musculoskeletal system and connective tissue: pain in the legs.
Urinary system disorders: urinary retention, dysuria, frequent urination.
General disorders: asthenia.
Other: conjunctivitis, stomatitis.
Since the pituitary gland is outside the blood-brain barrier, domperidone may increase prolactin levels. In rare cases, such hyperprolactinemia may lead to neuroendocrine side effects such as galactorrhea, gynecomastia, and amenorrhea. During post-marketing use of the drug, no differences in the safety profile of the drug in adults and children were noted, except for extrapyramidal disorders and other phenomena, seizures and agitation related to the central nervous system, which were observed predominantly in children.