Domperidone
Domperidone maleate
Also known as: Motilium · Equidone · Leisguard · Domperidonum · R-33812
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| As a prokinetic agent | 0.05-0.1 mg/kg PO once or twice a day | PO | q12-24h | — | 🌎 NA |
| For vomiting due to gastritis | 2-5 mg (total dose) PO two to three times a day | PO | q8-12h | — | 🌎 NA |
| Antiemetic / Prokinetic | 0.1 - 0.5 mg/kg | PO | q8h-q12h | As needed | 🌍 EU |
| Leishmaniasis (Treatment and Prevention) | 0.5 mg/kg | PO | sid | 28 days | 🌍 EU |
- As a prokinetic agent: Scant clinical experience; suggested dose based upon experimental data.
- Antiemetic / Prokinetic: Administer 15-30 minutes before feeding.
- Leishmaniasis (Treatment and Prevention): For prevention, the 28-day course can be repeated every 3-4 months depending on infection risk.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| As a prokinetic agent | 0.05-0.1 mg/kg PO once or twice a day | PO | q12-24h | — | 🌎 NA |
| Antiemetic / Prokinetic | 0.1 - 0.5 mg/kg | PO | q8h-q12h | As needed | 🌍 EU |
- As a prokinetic agent: Scant clinical experience; suggested dose based upon experimental data.
- Antiemetic / Prokinetic: Administer 15-30 minutes before feeding.
Horses
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| For fescue toxicity | 1.1 mg/kg PO once daily starting 10 to 15 days prior to Expected Foaling Date (EFD) | PO | q24h | Up to 5 days after foaling if inadequate milk | 🌎 NA |
- For fescue toxicity: Treatment may be continued for up to 5 days after foaling if mares are not producing adequate milk.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Domperidone is a peripherally acting dopamine-2 (D2) receptor antagonist utilized primarily as a gastrointestinal prokinetic and antiemetic agent, as well as a prolactin-release stimulant.
Key clinical applications include:
- Horses: Prevention and treatment of tall fescue toxicosis in periparturient mares, stimulation of lactation (agalactia), and as a diagnostic agent for Equine Pituitary Pars Intermedia Dysfunction (PPID / Equine Cushing's).
- Small Animals: Used off-label as a prokinetic and antiemetic, particularly for conditions involving delayed gastric emptying.
Clinical Pearl: Unlike metoclopramide, domperidone does not readily cross the blood-brain barrier. This significantly reduces the risk of central nervous system (CNS) side effects, such as extrapyramidal signs (tremors, twitching), making it an attractive alternative for patients sensitive to centrally acting prokinetics.
Mechanism of action
Domperidone exerts its effects through multiple pathways:
- Dopamine-2 (D2) Receptor Antagonism in the GI tract → enhances gastric motility and accelerates gastric emptying (prokinetic effect).
- D2 Receptor Antagonism in the Chemoreceptor Trigger Zone (CRTZ) → blocks emetic signaling (antiemetic effect). Because the CRTZ lacks a complete blood-brain barrier, domperidone can act here without entering the deeper CNS.
- Alpha-2 and Beta-2 Adrenergic Receptor Antagonism → provides additional modulatory effects on stomach motility.
- Pituitary Gland Disinhibition → Dopamine normally inhibits prolactin release. By blocking dopamine receptors, domperidone → increases prolactin secretion → stimulates milk production (galactagogue effect). This directly counteracts the dopamine-mimetic alkaloids found in toxic tall fescue.
Safety & warnings
Contraindications
- Known hypersensitivity to domperidone
- Presence or suspicion of gastrointestinal obstruction, perforation, or hemorrhage
- Pregnant mares >15 days prior to expected foaling date (unless specifically managed)
- Horses intended for human consumption
- Gastrointestinal hemorrhage
- Mechanical GI obstruction or perforation
- Prolactin-secreting pituitary tumors (prolactinomas)
- Known hypersensitivity to the drug
Adverse effects
- Galactorrhea (inappropriate milk production)
- Gynecomastia
- Premature lactation in horses (dripping milk prior to foaling)
- Failure of passive transfer in foals
- Rarely: somnolence or dystonic reactions
- Arrhythmias (associated with withdrawn injectable human products, especially with hypokalemia or heart disease)
- Galactorrhea (milk production in females)
- Mammary gland hyperplasia
- Changes in estrus cycle
- Mild gastrointestinal upset
Precautions
MDR1 Mutation Warning: Domperidone is potentially a neurotoxic substrate of P-glycoprotein. Use with extreme caution in herding breeds (e.g., Collies, Australian Shepherds) that may possess the MDR1 (ABCB1) gene mutation causing a nonfunctional blood-brain barrier efflux pump.
- Foal Immunity: In horses, failure of passive transfer of immunoglobulins (IgG) may occur even without visible leakage of colostrum. All foals born to treated mares must be tested for serum IgG concentrations.
- Reproductive Impact: May lead to premature birth, low birth weight, or foal morbidity if administered >15 days prior to the expected foaling date. Accurate breeding dates are essential.
- Laboratory Alterations: May increase serum prolactin, ALT, and AST. Can cause false-positive results on milk calcium tests used to predict foaling.
Drug interactions
May increase domperidone levels due to metabolic inhibition.
May reduce the gastrointestinal prokinetic efficacy of domperidone.
Domperidone may antagonize their dopamine-agonist effects on prolactin.
May increase domperidone levels.
May reduce the gastrointestinal prokinetic efficacy of domperidone.
Domperidone may alter the absorptive characteristics of these drugs by decreasing GI transit times.
May decrease the oral absorption of domperidone
May decrease the oral absorption of domperidone due to altered gastric pH
Inhibits CYP3A4 metabolism of domperidone, potentially increasing plasma concentrations and risk of QT prolongation
Inhibits CYP3A4 metabolism of domperidone, increasing plasma concentrations.
May antagonize the gastrokinetic effects of domperidone.
Increase gastric pH, which may decrease the oral absorption of domperidone. Administer at least 2 hours apart.
Monitoring
- Clinical efficacy (resolution of vomiting, improved gastric emptying, or adequate milk production)
- Serum IgG concentrations in foals born to treated mares
- Serum prolactin levels (if indicated)
- Resolution of nausea and vomiting
- Improvement in clinical signs of Leishmaniasis (if used for this indication)
- Signs of galactorrhea, mammary enlargement, or false pregnancy in females
Pharmacokinetics
Half-life
Absorption
Absorbed from the GI tract, but bioavailability in dogs is low (~20%) due to a high first-pass effect. Peak serum levels occur about 2 hours after oral dosing.
Distribution
Highly bound (93%) to serum proteins. Does not readily cross the blood-brain barrier.
Metabolism
Primarily metabolized in the liver.
Elimination
Metabolites are excreted in the feces and urine.
Overdose
There is no specific antidote for a domperidone overdose.
- Employ standard gastrointestinal decontamination procedures if ingestion is recent and the patient is asymptomatic.
- Provide supportive and symptomatic care as needed. Monitor for potential neurological signs (especially in MDR1-mutant dogs) or gastrointestinal upset.
Available products
Formulations
- Oral gel
- Tablets
- Suppositories
- 10 mg tablet
- 1 mg/ml oral suspension
- 5 mg/ml oral suspension (veterinary)
Veterinary
- Domperidone Oral Gel 11% (110 mg/mL) in 25 mL multi-dose oral syringes (Equidone® Gel)
- Leisguard 5 mg/ml oral suspension (EU)
Human-labeled
- 10 mg oral tablets (Canada/Europe)
- Oral suspension (Europe)
- Suppositories (Europe)
- Motilium 10 mg tablets
- Motilium 1 mg/ml oral suspension
Regulatory status
Approved for veterinary use in several EU countries specifically for the management of canine leishmaniasis (e.g., Leisguard).
Human formulations (POM) are used under the prescribing cascade.
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Domperidone gel should be stored at controlled room temperature 25°C (77°F) with excursions between 15°-30°C (59°-86°F) permitted. Recap after each use. Domperidone tablets should be stored at room temperature and protected from light and moisture.
Client information
- Purpose: Domperidone is used to improve stomach emptying and reduce nausea in dogs and cats. In horses, it is used to prevent complications from eating toxic fescue grass and to stimulate milk production in nursing mothers.
- Administration: Give exactly as directed by your veterinarian.
- Human Safety Warning: Pregnant and lactating women should use extreme caution when handling the equine gel product, as systemic exposure can affect human reproductive hormones. Wear gloves and wash hands thoroughly.
- Side Effects: You may notice inappropriate milk production or breast enlargement in pets. In horses, milk may drip before the foal is born. Contact your veterinarian if you notice any unusual lethargy, twitching, or behavioral changes.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.