Dompéridone Réponse Dr Newman mars 2012 .pdf

Nom original: Dompéridone - Réponse Dr Newman - mars 2012.pdf
Titre: Dompéridone - Réponse Dr Newman - mars 2012
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Réponse du Dr Jack Newman par rapport à l’avis de Santé Canada sur le
Dompéridone (mars 2012)
Below please find an analysis of the two studies that caused Health Canada to publish a warning about domperidone.
Done by one of the paediatricians working in our clinic.
The recent Health Canada-endorsed warning about the use of domperidone was based on two studies1,2 published in
The following KEY points regarding the studies are important to highlight:
• The information in these studies was taken from databases (one in the Netherlands2 and one in Saskatchewan1) and
did not demonstrate that domperidone caused any adverse health effects. To show a cause and effect, the studies would
have to be, amongst other things, prospective, and these were not. There are many other limitations with these studies.
For example, some key pieces of information are unavailable including smoking status, use of other non-prescription
drugs, and more, all of which can be important factors1.
• The average age of the patients in the studies was 72.5 years in one2 and 79.4 years in the other1. Many of the
patients in the studies had pre-existing health problems such as high blood pressure, coronary artery disease, and
congestive heart failure. Thus the warnings were based on information gathered from an entirely different population
than those who take Domperidone for breastfeeding purposes. Results in this age group cannot readily be applied to a
younger, healthier population. In fact, in one of the studies1, the authors concluded that the risk of a cardiac problem
related to taking domperidone in younger patients was much lower than in older patients. The risk quoted in younger
patients was almost the same as that outcome occurring by chance alone. That study also specifies that the risk in
females was significantly lower than in males. It is also important to highlight that the risk decreased the longer the
patient had been on domperidone.
• The warning regarding use of Domperidone in higher doses was based on only one of the studies2; the other study1 did
not include any information about dosing. In the study that included dosing information, out of the 1304 deaths that were
studied, only 10 patients were taking domperidone at the time of death. Of those 10 taking domperidone, only FOUR
patients were documented to be taking higher doses of domperidone (>30mg per day). Thus this Health Canadaendorsed dose-related warning came from dosing data compiled from FOUR patients total.
• Domperidone is generally used to treat gastro-intestinal problems such as acid reflux. Some of the symptoms of acid
reflux (eg chest-pain) are similar to symptoms of heart disease. It is possible that some patients were taking
Domperidone for what was thought to be a gastro-intestinal problem when, in fact, the symptoms may have been related
to a heart problem. While the authors attempted to account for this possibility2, it is hard to tease out those taking
domperidone for a gastro-intestinal symptom that was actually a heart condition.
• Furthermore, because domperidone is available over-the-counter in much of Europe specifically the Netherlands, it is
possible that the number of people self-medicating with domperidone is higher than the rate actually quoted in the Dutch
study (as the study only took into account prescriptions for Domperidone2 and not over-the-counter use). This important
fact may have skewed the results.
• Finally, the authors of one of the studies2 suggested that “for clinicians, it is important to avoid prescribing
Domperidone to patients with a high risk of sudden cardiac death”. They were not cautioning physicians not to prescribe
higher doses, but simply to exercise caution in patients considered higher risk.
In summary, breastfeeding mothers using domperidone are generally younger, healthy females. They do not fall into the
same demographics as the patients involved in the studies from which the warnings were generated. Furthermore, with
caution about the use of higher doses of domperidone stemming from a study where so few patients were actually on
those higher doses, the Health Canada-endorsed warning regarding the use of domperidone in higher doses seems to be
an over-reaction. Finally, with the other drawbacks of these studies outlined above, there is no evidence that
domperidone actually causes heart problems.
1 Johannes CB et al. Risk of serious ventricular arrhythmia and sudden cardiac death in a cohort of users of domperidone:
a nested case-control study. Pharmacoepidemiol Drug Saf. 2010 Sep; 19(9): 881-888.
2 van Noord C et al. Domperidone and ventricular arrhythmia or sudden cardiac death: a population-based case-control
study in the Netherlands. Drug Saf. 2010 Nov 1; 33(11): 1003-1014.

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