The Controversy Surrounding Domperidone: Risks, Benefits, and What You Need to Know

Domperidone is a drug that helps with nausea and vomiting, and it’s been used for decades to treat digestive issues like gastroparesis and reflux. But in many countries, including the U.S., Canada, and Australia, it’s either banned or tightly restricted. In others, like New Zealand and parts of Europe, it’s still available-often without a prescription. So why the split? And is it safe to use if you’re considering it for yourself or a loved one?

What Domperidone Actually Does

Domperidone works by blocking dopamine receptors in the brain and gut. Unlike metoclopramide, another common anti-nausea drug, it doesn’t cross the blood-brain barrier easily. That means it’s less likely to cause drowsiness or movement disorders like tardive dyskinesia. Instead, it speeds up stomach emptying and reduces feelings of fullness or nausea. It’s commonly prescribed for people with diabetic gastroparesis, chemotherapy-induced nausea, or even severe morning sickness during pregnancy-though not always approved for that last use.

Many people turn to domperidone because other options don’t work or cause worse side effects. For example, someone with chronic nausea after gastric surgery might find relief with domperidone when metoclopramide makes them feel worse. In New Zealand, where it’s available over the counter in pharmacies, it’s a go-to for parents dealing with babies who spit up excessively or adults with functional dyspepsia.

The Heart Risk That Sparked the Ban

The controversy started in the early 2000s when health agencies noticed a pattern: people taking high doses of domperidone, especially over long periods, were having rare but serious heart rhythm problems. Specifically, a condition called QT prolongation, which can lead to torsades de pointes-a potentially fatal irregular heartbeat.

In 2004, Health Canada issued a warning after reviewing 21 cases of cardiac arrest linked to domperidone. By 2014, they banned its use for non-prescription purposes and restricted it to short-term use at the lowest effective dose. The U.S. FDA followed suit, blocking importation and warning that domperidone wasn’t approved for any use in the country. The European Medicines Agency also limited its use, saying it should only be used for nausea and vomiting, not for increasing milk supply.

Here’s the catch: most of those heart events happened in people taking more than 30 mg per day, often for months or years. Many were also taking other drugs that affected heart rhythm, like certain antibiotics or antidepressants. The risk isn’t zero, but it’s also not common-especially at standard doses under 10 mg three times a day.

Off-Label Use: Lactation and Misuse

One of the biggest drivers of domperidone’s popularity-and its controversy-is its off-label use to increase breast milk supply. While it’s not approved for this purpose anywhere, many lactation consultants and breastfeeding support groups recommend it. Studies show it can raise prolactin levels and improve milk volume in some women, especially those with low supply due to hormonal imbalances or premature birth.

But here’s where it gets risky: women often self-medicate. They buy domperidone online from overseas pharmacies, sometimes without knowing the correct dose or duration. Some take 20 mg or more daily for months. There are documented cases of women developing arrhythmias after using it for lactation, even when they had no prior heart issues.

Pharmacists in New Zealand are required to counsel patients on this risk. But not everyone listens. A 2023 review in the New Zealand Medical Journal found that nearly 40% of women using domperidone for lactation were unaware of the heart risks-and most had no baseline ECG before starting.

Who Should Avoid Domperidone?

Domperidone isn’t safe for everyone. You should not take it if:

• You have a history of heart rhythm disorders, including QT prolongation
• You’re taking other medications that affect heart rhythm (like erythromycin, fluconazole, or some antidepressants)
• You have liver disease-domperidone is processed by the liver, and impaired function raises blood levels
• You’re over 60 and have other risk factors for heart disease
• You’re pregnant and not under medical supervision

Even if you’re young and healthy, taking domperidone for more than a few weeks without monitoring is risky. A simple ECG before starting-and one after a month-can catch early signs of QT prolongation. Blood tests to check liver function are also recommended if you’re on it long-term.

Alternatives That Work

If you’re avoiding domperidone because of the risks, there are other options. For nausea:

• Metoclopramide works similarly but carries a higher risk of neurological side effects. Best for short-term use.
• Ondansetron (Zofran) is often used for chemotherapy or post-op nausea. It’s more expensive but has a cleaner cardiac profile.
• Vitamin B6 combined with doxylamine is the first-line treatment for morning sickness in many countries, including the U.S.

For low milk supply, non-drug options matter just as much:

• More frequent nursing or pumping
• Proper latch and positioning
• Galactagogues like fenugreek or blessed thistle (though evidence is mixed)
• Addressing underlying stress, sleep deprivation, or thyroid issues

Domperidone might help, but it shouldn’t be the first or only tool. Many women improve milk supply with consistent support and time-no pills needed.

Why Is It Still Available in Some Places?

Regulators don’t agree on the risk-benefit balance. In New Zealand, the Medsafe agency allows domperidone to be sold without a prescription because they believe the benefits outweigh the risks when used correctly. They require pharmacists to provide written warnings and limit pack sizes to 30 tablets.

Meanwhile, in the U.S., the FDA says the drug’s risks aren’t well enough understood to approve it. But because it’s available online, Americans still get it-often from unregulated sources. A 2022 study found that 72% of domperidone sold online to U.S. customers didn’t match the labeled dosage. Some contained no active ingredient at all.

The truth? Domperidone isn’t a miracle drug. It’s a tool-with clear limits. When used short-term, at low doses, and under supervision, it can be helpful. But when misused, it can turn dangerous.

What to Do If You’re Considering Domperidone

If you’re thinking about using domperidone-for nausea, gastroparesis, or lactation-here’s what to do:

1. Don’t buy it online. Use a licensed pharmacy that requires a consultation.
2. Ask your doctor or pharmacist for a baseline ECG before starting.
3. Stick to 10 mg three times a day-never more unless supervised.
4. Use it for no longer than four weeks without a review.
5. Watch for symptoms like dizziness, palpitations, or fainting. Stop immediately and seek help.
6. Explore non-drug options first, especially if you’re breastfeeding.

The goal isn’t to scare you away from domperidone. It’s to make sure you use it wisely. Millions have taken it safely. But every year, someone learns the hard way that this drug isn’t harmless. Knowledge is your best protection.

If you’re managing chronic nausea, low milk supply, or digestive discomfort, domperidone might seem like a quick fix. But it’s not a shortcut. It’s a medication with real risks and real limits. The best outcomes come not from taking the pill, but from understanding when-and when not-to use it.