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Current Use of Domperidone and Co-prescribing of Medications that Increase Its Arrhythmogenic Potential Among Older Adults: A Population-Based Cohort Study in Ontario, Canada

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Abstract

Background and Objectives

Domperidone is commonly used to treat nausea and gastrointestinal disorders. Recent data suggests that it may increase the risk of sudden cardiac death, particularly in older people. Little is known about how it is used in contemporary practice. This study sought to characterize the population of older adults newly dispensed domperidone, describe dosages of domperidone used, and determine the frequency of co-prescribing domperidone with medications that may increase the arrhythmogenic potential of domperidone.

Methods

This is a retrospective cohort study using administrative health database information from Ontario, Canada. Prescription medication records were obtained from the Ontario Drug Benefit Claims Database. Diagnostic codes were obtained from the Ontario Health Insurance Plan Database, the Canadian Institute for Health Information Discharge Abstract Database, and the same-day surgery database. Patients who received a new prescription for domperidone between April 1, 2003 and March 31, 2010 were included.

Results

A total of 122,233 patients met inclusion criteria; 85 % were between 66 and 84 years old and 63 % were female. The mean estimated daily domperidone dose was 35 mg, and the estimated daily dose was <40 mg for 62 % of users. Strong or moderately strong cytochrome P-450 (CYP) 3A4 inhibitors were co-prescribed for 4.3 and 10.7 % of users, while medications with a known risk or possible risk for torsades de pointes (TdP) were co-prescribed to 18.3 and 18.8 % of users.

Conclusions

Older domperidone users were commonly co-prescribed drugs with the potential to increase the risk for TdP. These combinations should be avoided, as iatrogenic QT prolongation is a modifiable risk factor for TdP.

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Acknowledgments

This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

This study was funded by a Team Grant (OTG-88591) from the Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes.

Douglas S. Lee was supported by a CIHR clinician-scientist award. We thank Brogan Inc., Ottawa for use of their Drug Product and Therapeutic Class Database.

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Authors and Affiliations

  1. Schlegel Research Chair in Geriatric Pharmacotherapy, Schlegel-UW Research Institute for Ageing, University of Waterloo, 10 Victoria St S, Room 7004, Kitchener, ON, N2G 1C5, Canada

    Carlos Rojas-Fernandez

  2. School of Pharmacy, University of Waterloo, 10 Victoria St S, Room 7004, Kitchener, ON, N2G 1C5, Canada

    Carlos Rojas-Fernandez

  3. School of Public Health and Health Systems, University of Waterloo, 10 Victoria St S, Room 7004, Kitchener, ON, N2G 1C5, Canada

    Carlos Rojas-Fernandez

  4. Department of Family Medicine, McMaster University School of Medicine, 10 Victoria St S, Room 7004, Kitchener, ON, N2G 1C5, Canada

    Carlos Rojas-Fernandez

  5. Division of Respirology, St. Michael’s Hospital, Li Ka Shing Knowledge Institute, Department of Medicine, University of Toronto, 30 Bond Street, 6th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada

    Anne L. Stephenson

  6. Institute for Clinical Evaluative Sciences, Rm G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Hadas D. Fischer, Xuesong Wang, Douglas S. Lee & Paula A. Rochon

  7. Parkinson’s Disease and Movement Disorders Clinic, Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Canada

    Tiago Mestre

  8. The Ottawa Hospital-Civic Campus, 1053 Carling Ave., Floor C2, Room 2244, Ottawa, ON, K1Y 4E9, Canada

    Tiago Mestre

  9. Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Janine R. Hutson

  10. Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s Disease, UHN and University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada

    Margarita Pondal

  11. Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Canada

    Douglas S. Lee

  12. Women’s College Research Institute, Women’s College Hospital, 790 Bay Street, Toronto, M5G 1N8, Canada

    Paula A. Rochon

  13. Department of Medicine, Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Paula A. Rochon

  14. Toronto Western Hospital Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s Disease, University of Toronto, 7McL, 399 Bathurst ST., Toronto, ON, M5T 2S8, Canada

    Connie Marras

Authors
  1. Carlos Rojas-Fernandez
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  2. Anne L. Stephenson
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  3. Hadas D. Fischer
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  4. Xuesong Wang
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  5. Tiago Mestre
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  6. Janine R. Hutson
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  7. Margarita Pondal
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  8. Douglas S. Lee
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  9. Paula A. Rochon
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  10. Connie Marras
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Corresponding author

Correspondence to Carlos Rojas-Fernandez.

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Rojas-Fernandez, C., Stephenson, A.L., Fischer, H.D. et al. Current Use of Domperidone and Co-prescribing of Medications that Increase Its Arrhythmogenic Potential Among Older Adults: A Population-Based Cohort Study in Ontario, Canada. Drugs Aging 31, 805–813 (2014). https://doi.org/10.1007/s40266-014-0215-z

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  • DOI: https://doi.org/10.1007/s40266-014-0215-z

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