Diarrhea Associated with Domperidone and Esomeprazole

Medication Usage and Side Effects

Domperidone is used for treating gastroparesis symptoms at doses of 10 mg three times daily, with maximum dosing of 20 mg three to four times daily, and it improves gastric emptying and increases lower esophageal sphincter pressure, which can affect overall gastrointestinal motility 1

If diarrhea develops while using domperidone and esomeprazole together, assess severity using clinical grading (mild, moderate, severe) and evaluate for dehydration 2, 3
For mild diarrhea, symptomatic treatment with oral rehydration may suffice 2
Elderly patients are at higher risk for dehydration complications from medication-induced diarrhea and require closer monitoring 4
Rule out other causes of diarrhea including infection, dietary changes, or concurrent medications before attributing symptoms solely to domperidone or esomeprazole 5, 6

The American College of Gastroenterology recommends that domperidone, a prokinetic agent, does not worsen pre-existing diarrhea in the same way that antimotility agents like loperamide would be contraindicated in inflammatory conditions, due to its mechanism of accelerating gastric emptying and intestinal motility 7
Domperidone's prokinetic action does not carry the same pathophysiologic danger of trapping pathogens or toxins as antimotility agents, according to the Infectious Diseases Society of America 7

The Centers for Disease Control and Prevention note that domperidone does not carry the same contraindications as loperamide in the setting of fever, bloody stools, or inflammatory conditions, due to its prokinetic action that accelerates intestinal transit 7