The studies supporting efficacy of domperidone in improving GER in infants are limited.104 The ability of oral domperidone to increase the pressure of the LES or to promote healing of reflux esophagitis has not been demonstrated in placebo-controlled trials. Most studies have been performed in older children, or investigate the effects of domperidone co-administered with other anti-reflux agents.104 Comparing domperidone to metoclopramide, elicited adverse effects on the central nervous system were more severe and more common with metoclopramide.108 Because very little domperidone crosses the blood-brain barrier, reports of central nervous system adverse effects, such as dystonic reactions, are rare.109 Domperidone is better tolerated than metoclo-pramide, since dystonic reactions (tremors) and anxiety are infrequent. Prolactin plasma levels may increase, owing to pituary gland stimula-tion.110 Somnolence was acknowledged by 49% of patients after 4 weeks of metoclopramide treatment compared with 29% of patients after 4 weeks of domperidone.108 A reduction in mental acuity was acknowledged by 33% of patients compared to 20% in the domperidone group. Akathisia, asthenia, anxiety and depression were also acknowl edged less often, and at a lower severity after 4 weeks of domperidone, although these differences were not significant. Domperidone possesses cardiac electrophysiological effects similar to those of cisapride and class III antiarrhythmic drugs.104 Intravenously administered domperidone clearly causes QT prolongation and ventricular fibrillation.111,112
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