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Domperidone Is Commonly Prescribed With Other QT-Interacting Drugs
TAKE-HOME MESSAGE
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A cohort of 155 patients prescribed domperidone was analyzed to evaluate co-prescription of other medications that may prolong the QT interval (QTc) and the frequency of EKG monitoring. Co-prescription of QT-interacting drugs was noted in 69.7% of patients. Baseline EKG was completed in 59 patients (38.1%), and 9 showed QTc prolongation at this time. Follow-up EKG was done in 40 patients (25.8%), and 13 showed QTc prolongation. All of the 13 patients with QTc prolongation had been given a concomitant medication that caused QTc prolongation. There were 221 nonfatal cardiac events reported in domperidone patients in the FDA Adverse Event Reporting System database in the 6 years prior to 2014, and 73.3% of these occurred in patients given other QT-interacting medications. In addition, co-prescription was seen in 35.1% of deaths and 26.2% of cardiac arrests.
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A high proportion of patients prescribed domperidone receive other medications that can prolong the QTc. Despite this, EKG monitoring remains inadequate.
abstract
This abstract is available on the publisher's site.
Access this abstract nowINTRODUCTION
Domperidone, a peripheral D2 dopamine receptor antagonist, has efficacy for treatment of nausea, dyspepsia, and gastroparesis. Domperidone prolongs the QT interval (QTc), and may cause life-threatening arrhythmias.
METHODS
Electronic medical records for all patients receiving domperidone in the NorthShore University HealthSystem from January 1, 2008 to December 1, 2013 were reviewed. All concomitant medications were noted. The coadministration of QT-interacting medications was determined. Electrocardiogram (EKG) evaluation before and during domperidone therapy was noted. A query of the FDA Adverse Event Reporting System (FAERS) database was also performed. Individual reports from the FAERS Web site from January 2008 to June 2014 were downloaded and analyzed. The database was queried for all reports of adverse events with domperidone. Coadministration of QT-interacting medications was noted. Cardiac events that potentially were related to prolongation of the QTc were examined.
RESULTS
In total, 108 of 155 patients (69.7%) were coprescribed QT-interacting drugs along with domperidone. Fifty-nine of 155 patients (38.1%) underwent a baseline EKG and 9 (15.3%) had prolongation of the QTc at initiation. Forty patients (25.8%) had a follow-up EKG and 13 (32.5%) had prolongation of the QTc. All 13 were coprescribed QT-interacting medications. On the FAERS, 221 nonfatal cardiac events were reported in domperidone patients; of these, 162 (73.3%) occurred in patients receiving QT-interacting medications. Coprescription occurred in 53 of 151 deaths (35.1%) and in 16 of 61 cardiac arrests (26.2%).
CONCLUSIONS
Coprescribing of QT-prolonging medications and inconsistent EKG monitoring occur in patients receiving domperidone, placing these patients at risk for arrhythmias.
Additional Info
Domperidone Is Commonly Prescribed With QT-Interacting Drugs: Review of a Community-Based Practice and a Postmarketing Adverse Drug Event Reporting Database
J. Clin. Gastroenterol. 2017 Jan 01;51(1)56-62, ED Ehrenpreis, G Roginsky, A Alexoff, DG SmithFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The paper by Ehrenpreis et al is yet another wake-up call for prescribers and health IT professionals. Like many earlier studies, this one shows how often interacting medicines are co-prescribed, resulting in harm. In addition, it shows that when drug safety systems fail to prevent drug interactions, important medicines are removed or kept from the market, leaving fewer good options for our patients. Since simple, interruptive “drug interaction alerts” are over-ridden 80% to 90% of the time, we can’t expect them to be effective.1 We must all work to implement patient-specific clinical decision support systems to assist prescribers.2,3 These systems improve prescribing and reduce the co-administration of interacting drugs such as those on the growing list of 132 QT-prolonging drugs (www.QTdrugs.org).4
References