Domperidone: Should It Be Taken Before or After Meals?

Domperidone is a fast-acting medication that is rapidly absorbed when taken on an empty stomach. Peak blood levels are typically reached within about one hour after administration. However, taking it after meals may delay its absorption, reducing its effectiveness when it's needed most. For optimal results, it is generally recommended to take domperidone 15 to 30 minutes before eating.

Another important consideration is the interaction between domperidone and medications that reduce stomach acid. Certain anti-acid drugs or gastric acid inhibitors can lower the bioavailability of domperidone, meaning less of the active ingredient reaches the bloodstream. Therefore, these medications should not be taken at the same time as domperidone. If both types of drugs are necessary, it's best to take domperidone before meals and the acid-reducing medications afterward.

As a peripheral dopamine receptor antagonist, domperidone works directly on the gastrointestinal tract by enhancing the tone of the lower esophageal sphincter, which helps prevent gastroesophageal reflux. It also promotes coordinated motility between the stomach and the duodenum, aiding digestion and reducing symptoms like nausea and vomiting. Importantly, domperidone has been shown to effectively prevent bile reflux without interfering with normal gastric acid secretion.

One of the key safety advantages of domperidone is that it does not easily cross the blood-brain barrier. This significantly reduces the risk of central nervous system side effects, such as extrapyramidal reactions, which are more commonly associated with other dopamine-blocking agents. Its antiemetic effect is primarily due to its dual action on peripheral dopamine receptors and those located outside the blood-brain barrier in the chemoreceptor trigger zone, rather than through direct central nervous system activity.