Children with congenital heart disease – Consider stopping domperidone therapy or discuss with parents/carers and ensure that cardiac monitoring is regularly performed. Consider offering an alternative treatment where appropriate.

Other children with established reflux or nausea and vomiting – Take no immediate action in patients already established on domperidone.   Consider reducing the dose (where appropriate) to 250microgram/kg three times a day at the next convenient review. Consider routine cardiac monitoring where there are concerns (e.g. cardiovascular instability,
concomitant CYP3A4 inhibitors prescribed).

In new patients, always give a proper trial of feed thickeners before considering pharmacological intervention – at least two weeks. In more serious cases, and after the introduction of thickeners then consider the benefits and risks of medical anti-reflux/anti-acid secretion treatment.

If domperidone is to be used, give an initial maximum of
250micrograms/kg three times a day. Where reflux or nausea is refractory to
this then give increased doses to a maximum of 400micrograms/kg (max
20mg) three times a day and recommend regular cardiac monitoring.

Patient Information Leaflet entitled “Domperidone for gastrooesophageal
reflux” available from www.medicinesforchildren.org.uk