Gastric stasis

Prescribing Notes:

General notes

• Pharmacologic treatment of gastric stasis or delayed gastric emptying in children aims to improve gastric emptying and gastroparesis associated symptoms. Prokinetic medicines are usually first line such as domperidone or erythromycin, alternative therapies include ondansetron or alimemazine. These medicines are associated with QT prolongation and patients at risk may require baseline and periodic ECG monitoring, under the guidance of the initiating specialist. Avoid concurrent use with drugs that can prolong the QT interval.
• For recommendations on nausea and vomiting due to gastric stasis in paediatric palliative care refer to The Association of Paediatric Palliative Medicine guidance for more information.

Domperidone

• The MHRA have highlighted that domperidone may prolong the QT interval in adults, although no current evidence exists in children. Avoid co-prescribing with medicines which are known to prolong the QT interval.
• Key elements of the MHRA advice is domperidone should be used at the lowest effective dose for the shortest possible time. MHRA advice also notes that due to no evidence of benefit over placebo, domperidone is no longer licensed in under 12 years of age or those weighing less than 35kg.
• Patients currently receiving long term treatment with domperidone should be reassessed at a routine appointment to advise on treatment continuation, dose change or stopping treatment. See flow chart for further guidance.
• Domperidone dosing for gastric stasis in children is based on local specialist consensus, specialist may use higher doses in selected cases. Patients and their carers should be told how to recognise signs of arrhythmia and advised to seek medical attention if symptoms such as dizziness, palpitation or syncope develop.
• Domperidone treatment is contraindicated in patients with underlying cardiac conditions and other risk factors. Consult prescribing literature for further information.