RESUMEN
BACKGROUND: Domperidone is widely prescribed in patients with gastrointestinal disorders but some cardiac adverse effects have been recently reported. AIM: To evaluate the risk of QT prolongation, ventricular arrhythmias and sudden cardiac death associated with the use of oral domperidone in adults without cancer. MATERIAL AND METHODS: Systematic searches in MEDLINE, LILACS, SciELO, the Cochrane Library and regulatory agencies websites were performed, followed by a manual search of cited references. The search strategy consisted of combining free and indexed text words without any date or language restriction. RESULTS: Three case-control studies met the inclusion criteria; none of them evaluated QT interval prolongation. With low risk of bias, each study quantified the risk of ventricular arrhythmia or sudden cardiac death (VA/SCD). The odds ratios for these events in these studies were 4.7 (95% confidence interval (CI): 1.4-16), 1.59 (95% CI: 1.28-1.98) and 11.02 (95% CI: 2.02-62.3) respectively. A significantly increased risk was observed in patients older than 60 years of age or receiving doses > 30 mg/day. CONCLUSIONS: Heterogeneity between selected studies did not allow the computation of a summary measure. However, evidence was found that an increased risk of VA/SCD is associated with the use of oral domperidone in adults.
Asunto(s)
Antieméticos/efectos adversos , Arritmias Cardíacas/inducido químicamente , Muerte Súbita Cardíaca/etiología , Domperidona/efectos adversos , Adulto , Femenino , Reflujo Gastroesofágico/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Náusea/tratamiento farmacológico , Oportunidad Relativa , Factores de Riesgo , Vómitos/tratamiento farmacológicoRESUMEN
Background: Domperidone is widely prescribed in patients with gastrointestinal disorders but some cardiac adverse effects have been recently reported. Aim: To evaluate the risk of QT prolongation, ventricular arrhythmias and sudden cardiac death associated with the use of oral domperidone in adults without cancer. Material and Methods: Systematic searches in MEDLINE, LILACS, SciELO, the Cochrane Library and regulatory agencies websites were performed, followed by a manual search of cited references. The search strategy consisted of combining free and indexed text words without any date or language restriction. Results: Three case-control studies met the inclusion criteria; none of them evaluated QT interval prolongation. With low risk of bias, each study quantified the risk of ventricular arrhythmia or sudden cardiac death (VA/SCD). The odds ratios for these events in these studies were 4.7 (95% confidence interval (CI): 1.4-16), 1.59 (95% CI: 1.28-1.98) and 11.02 (95% CI: 2.02-62.3) respectively. A significantly increased risk was observed in patients older than 60 years of age or receiving doses > 30 mg/day. Conclusions: Heterogeneity between selected studies did not allow the computation of a summary measure. However, evidence was found that an increased risk of VA/SCD is associated with the use of oral domperidone in adults.
Asunto(s)
Animales , Femenino , Humanos , Ratones , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Diterpenos/administración & dosificación , Compuestos Epoxi/administración & dosificación , Paclitaxel/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/química , Apoptosis/efectos de los fármacos , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Línea Celular Tumoral , Diterpenos/química , Sinergismo Farmacológico , Compuestos Epoxi/química , Lactonas/administración & dosificación , Lactonas/química , Ratones Desnudos , Estrés Oxidativo/efectos de los fármacos , Poli(ADP-Ribosa) Polimerasas/genética , Poli(ADP-Ribosa) Polimerasas/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Relación Estructura-Actividad , Activación Transcripcional/efectos de los fármacos , Carga Tumoral , Ensayos Antitumor por Modelo de XenoinjertoRESUMEN
AIMS: To assess the association of the use of domperidone in infants with QTc interval prolongation and proarrhythmic events. METHODS: A systematic search of the scientific literature was conducted without any date or language restriction. The electronic database MEDLINE and the sources LILACS, ScIELO and Cochrane library were consulted. RESULTS: From the twelve identified studies, eight were excluded because they did not meet the inclusion criteria. One case report and three pilot studies were selected. Rocha et al (2005) reported the case of an infant (age 3 months) with QTc interval = 463 ms after being treated during one month with 1.8 mg/kg/day of oral domperidone. Djeddi et al (2008) administered an average dose of 1.3 mg/kg/day to 31 neonates; QTc interval prolongation > 30 ms was observed in nine neonates. Hegar et al (2009) studied 10 infants (mean age 5.6 months) who received 0.8 mg/ kg/day of oral domperidone; QTc interval prolongation was not observed. Günlemez et al (2010) enrolled 40 premature infants who were administered 1 mg/kg/day of oral domperidone; the QTc interval increased to above 450 ms in two infants. CONCLUSIONS: Although evidence that orally administrated domperidone in infants produces prolongation of QTc interval was found, further studies are needed in order to quantify the risk associated with the drug in that population. We suggest that heath professionals should conduct ECGs to infants treated with domperidone and inform the pharmacovigilance system the occurrence of any case of adverse event.
Objetivo: Determinar si existe evidencia de prolongación del intervalo QTc y efectos proarrítmicos asociados al uso de domperidona oral en infantes. Método: Se realizó una revisión sistemática de la literatura científica consultando la base de datos electrónica MEDLINE y las fuentes LILACS, ScIELO y Biblioteca Cochrane a través de la Biblioteca Virtual de Salud, sin límite de fecha ni de idioma. Resultados: De los estudios identificados se excluyeron ocho por no cumplir con los criterios de inclusión, quedando seleccionados un reporte de caso y tres estudios pilotos. Rocha et al (2005) reportan el caso de un niño de 3 meses con intervalo QTc=463 mseg tras un mes de tratamiento con 1,8 mg/kg/día de domperidona oral. Djeddi et al (2008) administraron una dosis promedio de 1,3 mg/kg/día a 31 neonatos, observando prolongación del intervalo QTc>30 mseg en nueve. Hegar et al (2009) estudiaron a 10 niños con edad media de 5,6 meses tratados con 0,8 mg/kg/día y no observaron prolongación del intervalo QTc. Gunlemez et al (2010) incluyeron en su estudio a 40 infantes prematuros a quienes administraron 1 mg/kg/día de domperidona oral, en dos de ellos el intervalo QTc aumentó por encima de 450 mseg. Conclusiones: Aunque se encontró evidencia de prolongación del intervalo QTc en infantes tratados con domperidona oral, se necesitan más estudios para cuantificar el riesgo asociado a la droga en esta población. Se sugiere a los profesionales de la salud realizar un monitoreo electrocardiográfico de los infantes tratados con domperidona e informar al sistema de farmacovigilancia los casos de ocurrencia de eventos adversos.
Asunto(s)
Arritmias Cardíacas/inducido químicamente , Domperidona/efectos adversos , Antagonistas de Dopamina/efectos adversos , Fibrilación Atrial/inducido químicamente , Cisaprida/farmacología , Cisaprida/uso terapéutico , Contraindicaciones , Citocromo P-450 CYP3A/fisiología , Domperidona/farmacocinética , Domperidona/uso terapéutico , Antagonistas de Dopamina/uso terapéutico , Interacciones Farmacológicas , Reflujo Gastroesofágico/tratamiento farmacológico , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/inducido químicamente , Síndrome de QT Prolongado/inducido químicamente , Proyectos Piloto , Estudios ProspectivosRESUMEN
Objetivo: Determinar si existe evidencia de prolongación del intervalo QTc y efectos proarrítmicos asociados al uso de domperidonaoral en infantes. Método: Se realizó una revisión sistemática de la literatura científica consultando la base de datos electrónica MEDLINEy las fuentes LILACS, ScIELO y Biblioteca Cochrane a través de la Biblioteca Virtual de Salud, sin límite de fecha ni de idioma. Resultados: De los estudios identificados se excluyeron ocho por no cumplir con los criterios de inclusión, quedando seleccionados un reporte de caso y tres estudios pilotos. Rocha etal (2005) reportan el caso de un niño de 3 meses con intervalo QTc=463 mseg tras un mes de tratamiento con 1,8 mg/kg/díade domperidona oral. Djeddi et al (2008) administraron unadosis promedio de 1,3 mg/kg/día a 31 neonatos, observando prolongación del intervalo QTc>30 mseg en nueve. Hegar et al (2009) estudiaron a 10 niños con edad media de 5,6 meses tratados con 0,8 mg/kg/día y no observaron prolongación del intervalo QTc. Gunlemez et al (2010) incluyeron en su estudio a 40 infantes prematuros a quienes administraron 1 mg/kg/día de domperidona oral, en dos de ellos el intervalo QTc aumentó por encima de 450 mseg. Conclusiones: Aunque se encontró evidencia de prolongación del intervalo QTc en infantes tratados con domperidona oral, se necesitan más estudios para cuantificar el riesgo asociado a la droga en esta población. Se sugiere a los profesionales de la salud realizar un monitoreo electrocardiográfico de los infantes tratados con domperidona e informar al sistema de farmacovigilancia los casos de ocurrencia de eventos adversos
Aims: To assess the association of the use of domperidone in infants with QTc interval prolongation and proarrhythmic events. Methods: A systematic search of the scientific literature was conducted without any date or language restriction. The electronic database MEDLINE and the sources LILACS, ScIELO and Cochrane library were consulted. Results: From the twelve identified studies, eight were excluded because they did not meet the inclusion criteria. One case report and three pilot studies were selected. Rocha et al (2005) reported the case of an infant (age 3 months) with QTc interval = 463ms after being treated during one month with 1.8 mg/kg/day of oral domperidone. Djeddi et al (2008) administered an average dose of 1.3 mg/kg/day to 31 neonates; QTc interval prolongation > 30 ms was observed in nine neonates. Hegar et al (2009) studied 10 infants (mean age 5.6 months) who received 0.8 mg/ kg/day of oral domperidone; QTc interval prolongation was not observed. Günlemez et al (2010) enrolled 40 premature infants who were administered 1 mg/kg/day of oral domperidone; the QTc interval increased to above 450 ms in two infants. Conclusions: Although evidence that orally administrated domperidone in infants produces prolongation of QTc interval was found, further studies are needed in order to quantify the risk associated with the drug in that population. We suggest that heath professionals should conduct ECGs to infants treated with domperidone and inform the pharmacovigilance system the occurrence of any case of adverse event