Mot Ilium Tab
Mot Ilium Tab
Mot Ilium Tab
domperidone
DATASHEET
1. PRODUCT NAME
Motilium 10 mg film-coated tablets
3. PHARMACEUTICAL FORM
Film-coated tablets
MOTILIUM 10 mg tablets are white, circular, film-coated, biconvex tablets with m/10 imprinted
on one side and JANSSEN on the other.
4. CLINICAL PARTICULARS
4.1 Therapeutic indications
Adults and adolescents weighing ≥ 35kg
Symptomatic treatment of the dyspeptic symptom complex that may be associated with delayed
gastric emptying such as epigastric sense of fullness, abdominal distension or swelling, or
epigastric pain or discomfort.
Treatment of acute symptoms of nausea and vomiting.
There is insufficient evidence to support the use of domperidone in childhood gastro-
oesophageal reflux disease. Domperidone may not be suitable for chemotherapy- or
radiotherapy-induced nausea and vomiting or post-operative nausea and vomiting.
Hepatic impairment
MOTILIUM is contraindicated for patients with moderate or severe hepatic impairment (see
section 4.3 Contraindications).
4.3 Contraindications
MOTILIUM is contraindicated in the following situations:
• Known hypersensitivity to domperidone or any of the excipients
• Prolactin-releasing pituitary tumour (prolactinoma)
• Use in children under 2 years of age. See also section 4.2 Dose and method of
administration and section 4.4 Special warnings and precautions for use.
• Co-administration with potent CYP3A4 inhibitors has been shown to increase
domperidone concentrations to the point where QT interval prolongation may occur.
Examples of potent CYP3A4 inhibitors include some azole antifungals (eg,
intraconazole, voriconazole, posaconzazole), some macrolide antibiotics (eg,
clarithromycin, telithromycin), and some protease inhibitors (ritonavir, saquinavir,
telaprevir).
• Co-administration with medicines that prolong the QTc interval.
• MOTILIUM should not be used whenever stimulation of gastrointestinal motility might
be dangerous such as in the presence of gastrointestinal haemorrhage, mechanical
obstruction, or perforation.
• In patients with moderate or severe hepatic impairment (see section 5.2
Pharmacokinetic properties).
Intolerance to lactose
The film-coated tablets contain lactose and may be unsuitable for patients with lactose
intolerance, galactosemia or glucose/galactose malabsorption.
Prolactin levels
Renal impairment
Since the elimination half-life of domperidone is prolonged in severe renal impairment, the
dosing frequency of MOTILIUM should to be reduced to once or twice daily depending on the
severity of the impairment. The dose may also need to be reduced. Such patients with severe
renal impairment should be reviewed regularly (see sections 5.2 Pharmacokinetic
properties and 4.2 Dose and method of administration).
Hepatic Impairment
MOTILIUM is contraindicated for patients with moderate or severe hepatic impairment (see
section 4.3 Contraindications). Dose adjustment is not required for patients with mild hepatic
impairment (see section 5.2 Pharmacokinetic properties).
Infants
MOTILIUM tablets are unsuitable for use in children <12 years of age (see section 4.2 Dose
and method of administration).
Lactation
The amount of domperidone that could be ingested by an infant through breast milk is low.
The maximal relative infant dose (%) is estimated to be about 0.1% of the maternal weight-
adjusted dosage. It is not known whether this is harmful to the newborn. Therefore breast-
feeding is not recommended for women who are taking MOTILIUM.
ADRs that occurred in < 1% of Domperidone-treated patients in the 45 clinical trials (n=1221)
are listed below in Table 2.
The following adverse reaction has been reported with over-the-counter use: dry mouth.
Postmarketing
In addition to the adverse effects reported during clinical studies and listed above, the following
adverse drug reactions have been reported. In each table, the frequencies are provided
according to the following convention:
Very common ≥1/10
Common ≥1/100 and < 1/10
Uncommon ≥ 1/ 1,000 and < 1/100
Rare ≥1/10,000 and < 1/1,000
Very rare <1/10,000, including isolated reports.
In Table 3, ADRs are presented by frequency category based on spontaneous reporting rates,
when known.
Table 3. Adverse Drug Reactions Identified During Postmarketing Experience with
MOTILIUM by Frequency Category Estimated from Spontaneous Reporting Rates
Immune System Disorders
Very rare Anaphylactic Reaction (including Anaphylactic Shock)
Psychiatric Disorders
Very rare Agitation, Nervousness
Nervous System Disorders
Very rare Dizziness, Extrapyramidal Disorder, Convulsion
Cardiac Disorders
Very rare case reports of QTc prolongation, ventricular arrhythmia, and sudden death have
occurred with domperidone use. Although most reported cases have occurred in patients
receiving the intravenous form of domperidone, or in patients with other risk factors, an
association with oral domperidone cannot be completely ruled out. Therefore, domperidone
should be used with caution in patients with other risk factors for QTc prolongation including
hypokalaemia, severe hypomagnesaemia, structural heart disease, the concomitant
administration of QTc prolonging medicines, or an underlying genetic predisposition.
Extrapyramidal disorder occurs primarily in neonates and infants. Other central nervous system-
related effects of convulsion and agitation also are reported primarily in infants and children.
An increase in the risk of serious ventricular arrhythmias and sudden cardiac death has been
reported in some epidemiology studies. The risk may be higher in patients older than 60 years
or at total daily doses of more than 30mg. Domperidone should be used at the lowest effective
dose in adults. Due to the limitations of these data, the exact frequency of these adverse
reactions could not be defined.
Paediatric population
In postmarketing experience, there were no differences in the safety profile of adults and
children., with the exception of extrapyramidal disorder which occurred primarily in neonates
and infants (up to one year of age), and other central nervous system-related effects of
convulsion and agitation which were reported primarily in infants and children. See also section
4.2 Dose and method of administration and section 4.4 Special warnings and precautions
for use.
4.9 Overdose
Symptoms and signs
Overdose has been reported primarily in infants and children. Symptoms of overdosage may
include agitation, altered consciousness, convulsion, disorientation, somnolence and
extrapyramidal reactions.
Treatment
There is no specific antidote to domperidone. Anticholinergics, anti-Parkinsonian agents may
be helpful in controlling the extrapyramidal reactions. Close observation and supportive
therapy is recommended.
For advice on the management of overdose please contact the National Poisons Centre on
0800 POISON (0800 764766).
5. PHARMACOLOGICAL PROPERTIES
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Propulsives, ATC code: A03F A 03
Clinical Studies
Infants and children ≤ 12 years of age
A multicenter, double-blind, randomized, placebo-controlled, parallel-group, prospective study
was conducted to evaluate the safety and efficacy of domperidone in 292 children with acute
gastroenteritis aged 6 months to 12 years (median age 7 years). In addition to oral rehydration
treatment (ORT), randomized subjects received domperidone oral suspension at 0.25 mg/kg
(up to a maximum of 30 mg domperidone/day), or placebo, 3 times a day, for up to 7 days.
This study did not achieve the primary objective, which was to demonstrate that domperidone
suspension plus ORT is more effective than placebo plus ORT at reducing the percentage of
subjects with no vomiting episodes during the first 48 hours after the first treatment
administration. See also section 4.2 Dose and method of administration and section 4.4
Special warnings and precautions for use.
Distribution
Oral domperidone does not appear to accumulate or induce its own metabolism; a peak
plasma level after 90 minutes of 21 ng/mL after two weeks oral administration of 30 mg per
day was almost the same as that of 18 ng/mL after the first dose. Domperidone is 91 to 93%
bound to plasma proteins. Distribution studies with radiolabelled drug in animals have shown
wide tissue distribution, but low brain concentration. Small amount of drug cross the placenta
in rats.
Metabolism
Domperidone undergoes rapid and extensive hepatic metabolism by hydroxylation and
N-dealkylation. In vitro metabolism experiments with diagnostic inhibitors revealed that
CYP3A4 is a major form of cytochrome P-450 involved in the N-dealkylation of domperidone,
whereas CYP3A4, CYP1A2 and CYP2E1 are involved in domperidone aromatic hydroxylation
(see section 4.5 Interactions with other medicines and other forms of interactions).
Elimination
Urinary and faecal excretion amounts to 31 and 66%, respectively, of the oral dose. The
proportion of the medicine excreted unchanged is small (10% of faecal excretion and
approximately 1% of urinary excretion). The plasma half-life after a single oral dose is 7-9
hours in healthy subjects but is prolonged in patients with severe renal insufficiency.
Special Populations
Hepatic Impairment
In subjects with moderate hepatic impairment (Pugh score 7 to 9, Child-Pugh rating B), the
AUC and Cmax of domperidone is 2.9- and 1.5-fold higher, respectively, than in healthy
subjects. The unbound fraction is increased by 25%, and the terminal elimination half-life is
prolonged from 15 to 23 hours. Subjects with mild hepatic impairment have a somewhat lower
systemic exposure than healthy subjects based on Cmax and AUC, with no change in protein
binding or terminal half-life. Subjects with severe hepatic impairment were not studied (see
section 4.3 Contraindications).
Renal impairment
In studies with severe renal insufficiency (serum creatinine > 6 mg/100 mL, i.e., > 0.6 mmol/L)
the half-life of domperidone is increased from 7.4 to 20.8 hours, but plasma drug levels are
lower than in subjects with normal renal function. Very little unchanged drug (approximately
1%) is excreted via the kidneys (see section 4.4 Special warnings and precautions use).
6. PHARMACEUTICAL PARTICULARS
6.1 List of excipients
Lactose Maize starch
Microcrystalline cellulose
Pregelatinized potato starch
Povidone
Magnesium stearate
Hydrogenated cottonseed oil
Sodium lauryl sulfate
Hypromellose.
6.2 Incompatibilities
Not applicable.
7. MEDICINE SCHEDULE
Prescription Medicine.
8. SPONSOR
JNTL Consumer Health (New Zealand) Limited
Auckland, NEW ZEALAND
Australia: 1800 029 979
New Zealand: 0800 446 147
Overseas: +61 2 8260 8366