Does domperidone prolong QTc in a clinically relevant manner in infants with GORD?

• Published in: Archives of disease in childhood 2020-02, Vol.105 (2), p.202-205
• Main Authors: Ryan, Paul MacDaragh, Mondal, Tapas
• Format: Article
• Language: English
• Subjects: Age; Archimedes; Arrhythmia; Babies; Calcium; Cardiac arrhythmia; Case reports; Conduction; domperidone; Dosage; Drug dosages; EKG; Electrolytes; Gestational age; Health risk assessment; Heart Disorders; infant; Infants; Magnesium; Males; Multivariate analysis; Narcotics; Neonates; Newborn babies; Patients; Pediatrics; Population; Population studies; Potassium; Pregnancy; QTc; Tachycardia; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-318183

Prior to initiation of therapy, an ECG performed to exclude prolonged QT interval reveals a corrected QTc of 400msec and an electrolyte panel was found to be entirely within normal range. Of the articles excluded, three were concerned with the use of domperidone as a galactagogue agent in lactating mothers; two were case reports: one reporting a prolonged QT interval secondary to domperidone therapy and one in which an excessive dose of a liquid domperidone formulation was followed by a supraventricular tachycardia; one systematic review published in Spanish was excluded—however, all studies from this review were included. Table 1 Summary of included studies examining the QTc prolonging and arrhythmogenic effects of domperidone in infants treated for GORD Citation Population/groups/setting Study type/level of evidence Outcomes Key results Comments Djeddi et al 7 Population: 31 infants with GORD divided into three groups by GA with intended treatment with domperidone Groups: A: 40 weeks (n=13) B: 33 weeks (n=7) C: 28 weeks (n=11) Dose: 0.7–1.3 mg/kg/day Setting: Neonatology unit, France Prospective Cohort Study Level 2b ECG assessment (QTc and arrhythmia) prior to and roughly 2 days after commencing domperidone Routine bloods (serum K+, Ca2 +, Mg2+) were drawn and assessed for their relationship to QTc prolongation through multivariate analysis QTc calculated manually by Bazett’s formula The combined data revealed that domperidone prolonged the QTc in all groups from the baseline 373.2±4.8 msec to 387.2±5.1 msec (14 msec prolongation of the QTc interval in total dataset) Almost half of patients (48.4%) experienced QTc interval prolongation of more than 12 msec Prolongation1 of the QTc interval in the particular groups was as follows: A: 19.1±23.7 msec B: 26±14.4 msec C: −2.9±20.4 msec Serum K+ was found to be independently associated with QTc interval prolongation No arrhythmias or atrioventricular conduction issues were identified Despite the fact that the domperidone treatment prolonged the QTc interval overall and in infants with a GA of 40 weeks and 33 weeks, it did not prolong to an overtly arrhythmogenic degree In fact, as domperidone did not increase the QTc of 28-week GA infants at all, the authors suggest that the domperidone may in fact be safer than the alternative, cisapride, which they say has been found to alter cardiac conduction and QTc in this demographic No placebo group Hegar et al 10 Population: 20 roughly 5-month-old infants with GORD G