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Majdinasab E, Haque S, Stark A, Krutsch K, Hale TW. Psychiatric Manifestations of Withdrawal Following Domperidone Used as a Galactagogue. Breastfeed Med 2022; 17:1018-1024. [PMID: 36367713 DOI: 10.1089/bfm.2022.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Domperidone is a dopamine-2 antagonist used off-label to increase breast milk production. Dosages commonly promoted for lactation are often far above those of studied on-label indications and might pose additional risks, especially upon discontinuation of the drug. Patients: Three U.S. patients are presented who used domperidone for lactation and experienced varying degrees of psychiatric withdrawal symptoms lasting months during dosage tapering and after cessation. Conclusion: Domperidone as a galactagogue may pose a significant psychiatric risk upon discontinuation. This presentation is commonly confused with, but clinically distinct from, postpartum depression. Lactating mothers who present with psychiatric symptoms should be explicitly probed about domperidone use, even in areas where domperidone is not authorized for use. Maternal hesitancy to disclose domperidone use may lead to suboptimal outcomes for the patient and delay management of withdrawal manifestations. The best course of treatment remains unknown, but a slow hyperbolic taper to gently discontinue domperidone may minimize withdrawal symptoms in these patients. Individuals exploring domperidone use should be informed of potential risks upon withdrawal, including psychiatric manifestations, requisite taper, and potential impacts of using unstudied high doses.
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Affiliation(s)
- Elleana Majdinasab
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Sarah Haque
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Amy Stark
- Department of Psychiatry, and Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Kaytlin Krutsch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Thomas W Hale
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
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Abstract
Objectives: Domperidone is an antiemetic that is commonly used as an off-label prescription to induce lactation. Neuropsychiatric adverse effects of domperidone such as akathisia and depression are previously described. It has never been reported to be associated with infanticide ideation. The aim of this article is to discuss the occurrence of infanticide ideation following domperidone usage in an adoptive mother and the potential mechanisms by which these may occur. Methods: With Institutional Review Board approval, we herein report a nulliparous adoptive mother who developed infanticide ideation after 3 months of exposure to domperidone. The infanticide ideation was intrusive, recurrent, ego-dystonic, causing significant depressive symptoms and affecting the patient's functions. Physical examination and relevant biological investigations were unremarkable. Results: The patient is treated as domperidone-induced obsessional thought with adjustment disorder. The domperidone was stopped immediately. Serotonin and norepinephrine reuptake inhibitors was started. The infanticide ideation gradually resolved and patient achieved complete remission after 10 months of treatment. Conclusion: The infanticide ideation following consumption of domperidone is a potential neuropsychiatric adverse event that warrants further examination into the safety of domperidone as an "off-labeled" galactagogue. Comprehensive psychological assessment of mother who wishes to use domperidone as galactagogue is recommended.
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Affiliation(s)
- Rosnadia Suain Bon
- Department of Psychiatry, Faculty of Medicine and Defense Health, National Defense University of Malaysia, Kuala Lumpur, Malaysia
| | - Asma Assa'edah Mahmud
- Department of Psychiatry, Faculty of Medicine and Defense Health, National Defense University of Malaysia, Kuala Lumpur, Malaysia
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Sakran W, Abdel-Rashid RS, Saleh F, Abdel-Monem R. Ethosomal gel for rectal transmucosal delivery of domperidone: design of experiment, in vitro, and in vivo evaluation. Drug Deliv 2022; 29:1477-1491. [PMID: 35543451 PMCID: PMC9103489 DOI: 10.1080/10717544.2022.2072542] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Despite high efficiency of domperidone (DOM) in prophylaxis of emesis accompanied with radiotherapy and chemotherapy, it still can bother cancer patients by its powerful side effects and difficulty of its oral administration. The study was designed to develop and optimize DOM loaded ethosomal gel for rectal transmucosal delivery. Ethosomal formulations were prepared using a 21, 51 full-factorial design where the impact of lecithin concentration and additives were investigated. The optimum ethosomal vesicles were subsequently incorporated in Carbopol gel base where rheological behavior, spreadability, mucoadhesion, and in vivo pharmacokinetic parameters were studied. Based on Design Expert® software (Stat Ease, Inc., Minneapolis, MN), the optimum formulation illustrated entrapment efficiency of 70.02%±5.52%, and vesicular size of 112 ± 3.3 nm, polydispersity index of 0.32 ± 0.01, zeta potential of −59 ± 0.28 mV, and % drug released after 6 h of 76.30%±2.45%. Moreover, ex vivo permeation through rabbit intestinal mucosa increased four times compared to free DOM suspension. The gel loaded with ethosomes showed excellent mucoadhesion to rectal mucosa. DOM ethosomal gel showed a raise in Cmax and AUC0–48 of DOM by twofolds compared to free DOM gel. The study suggested that ethosomes incorporated in gels could be an efficient candidate for rectal transmucosal delivery of DOM.
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Affiliation(s)
- Wedad Sakran
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Rania S Abdel-Rashid
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Fatma Saleh
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Raghda Abdel-Monem
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Helwan University, Cairo, Egypt
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Cheng Y, Chen C, Yang H, Fu M, Zhong X, Wang B, Hu Z, He M, Zhang Z, Jin X, Kang Y, Wu Q. Association between Domperidone Administered via Feeding Tube and Feeding Success in Critically Ill Patients with Enteral Feeding Intolerance. J Pers Med 2021; 11:jpm11090846. [PMID: 34575623 PMCID: PMC8466316 DOI: 10.3390/jpm11090846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 02/05/2023] Open
Abstract
One nutritional challenge in critically ill patients is enteral feeding intolerance (EFI), but current prokinetic agents have uncertain efficacy and safety profiles. We conducted a longitudinal, single-center, retrospective study to evaluate the efficacy and safety of domperidone administered via the feeding tube versus intravenous (IV) metoclopramide among adult patients with EFI. The primary outcome was feeding success, defined as the proportion of patients with average percentage of daily protein prescription >80% of the target dose. The secondary outcomes were safety endpoints. Among 28,814 intensive care unit (ICU) admissions, 552 patients with EFI were included, 38 receiving IV metoclopramide and 514 receiving tube feeding domperidone. The proportion of feeding success in patients receiving tube feeding domperidone and IV metoclopramide was 42.02% and 21.05%, respectively. After 1:2 matching (IV metoclopramide to tube feeding domperidone), the proportion of feeding success was 40.79% in patients receiving tube feeding domperidone. Basically, after matching, there were no differences in any safety endpoints (mortality and length of stay during ICU and hospitalization, organ-support-treatment free days) or adverse events (recurrence of EFI, electrolyte disturbance, abdominal and other symptoms) between the two groups (p > 0.05). A logistic regression analysis in the matched cohort indicated that domperidone administered via the feeding tube was independently associated with feeding success. We found that tube feeding domperidone was efficient in increasing enteral nutrition delivery performance among critically ill adult patients with EFI.
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Affiliation(s)
- Yisong Cheng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610064, China;
| | - Hao Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Min Fu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Xi Zhong
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Zhi Hu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Xiaodong Jin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610064, China; (Y.C.); (H.Y.); (M.F.); (X.Z.); (B.W.); (Z.H.); (M.H.); (Z.Z.); (X.J.); (Y.K.)
- Correspondence: ; Tel.: +86-028-8542-2506
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Zidan AM, Saad EA, Ibrahim NE, Mahmoud A, Hashem MH, Hemeida AA. PHARMIP: An insilico method to predict genetics that underpin adverse drug reactions. MethodsX 2019; 7:100775. [PMID: 32123669 PMCID: PMC7036477 DOI: 10.1016/j.mex.2019.100775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 12/16/2019] [Indexed: 01/08/2023] Open
Abstract
Pharmacovigilance is the pharmacological science that focuses on the safe and appropriate use of drugs.Variability in response to drug therapy in both terms of safety and efficacy is highly related to patient's personal genomics. Hence, pharmacovigilance considers pharmacogenomics methodologies in the evaluation of medicinal products. The aim of this work is to introduce the pharmacovigilance/ pharmacogenomics insilico pipeline (PHARMIP) that uses the drug (or drug candidate) digital structure and the advances in bioinformatics tools and databases to figure-out the genetic factors underlying the drug reported adverse reactions (ADRs).PHARMIP uses user-friendly freely available bioinformatics resources to help pharmacovigilance and pharmacogenomics scientists with minimal bioinformatics experience to retrieve helpful information for their daily basis activities. Also, PHARMIP could help the advances in precision medicine in a drug-centric approach as it can be used to reveal genetic risk factors for certain drug ADRs. Domperidone was used as an example to the application of PHARMIP as the pipeline was initially developed during the insilico exploration of domperidone cardiotoxic ADRs. Method is composed of 3 main steps: Preparing the drug off-label targets (OLT) list. Retrieving the related diseases/ adverse reactions (DA) list. Analysis of DA list to get answers.
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Affiliation(s)
- Ahmad M Zidan
- Department of Bioinformatics, Genetic Engineering & Biotechnology Research Institute, University of Sadat City, Egypt
| | - Eman A Saad
- Department of Bioinformatics, Genetic Engineering & Biotechnology Research Institute, University of Sadat City, Egypt
| | - Nasser E Ibrahim
- Department of Bioinformatics, Genetic Engineering & Biotechnology Research Institute, University of Sadat City, Egypt
| | - Amal Mahmoud
- Department of Biology, College of Science, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, 31441, Dammam, Saudi Arabia
| | - Medhat H Hashem
- Department of Animal Biotechnology, Genetic Engineering & Biotechnology Research Institute, University of Sadat City, Egypt
| | - Alaa A Hemeida
- Department of Bioinformatics, Genetic Engineering & Biotechnology Research Institute, University of Sadat City, Egypt
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