Domperidone Use in Parkinson's May Double Risk for Mortality

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Patients currently using domperidone were found to be associated with the highest risk for all-cause mortality.
Patients currently using domperidone were found to be associated with the highest risk for all-cause mortality.

Patients with Parkinson disease who use domperidone to treat gastrointestinal symptoms may see their risk of all-cause mortality doubled — especially within the first 30 days of domperidone exposure — compared with patients who have never used domperidone, according to a study published in the British Journal of Clinical Pharmacology.

With this cohort study, investigators sought to examine the safety of domperidone exposure in patients with Parkinson disease who have a predisposition to cardiovascular abnormalities, and the risk for all-cause mortality associated with domperidone.

Data was drawn from the UK Clinical Practice Research Datalink database and included 5114 individuals without Parkinson's and 5114 patients diagnosed with Parkinson disease who were characterized by their domperidone exposure status: current, recent, past, or never. Present users were further categorized according to daily dose, duration of domperidone use, and concurrent use of other medications for treating Parkinson disease. Study participants were followed for ≥1 year, and the follow-up period was divided into 30-day segments. Risk factors were examined for all patients at the beginning of each 30-day period. The study's primary outcome, all-cause mortality, was assessed based on mortality codes established in the Clinical Practice Research Datalink.

Patients currently using domperidone were found to be associated with the highest risk for all-cause mortality (twofold increase) compared with patients who had never used domperidone. Participants with Parkinson's who received a treatment concurrent with domperidone were found to have the lowest risk for all-cause mortality among individuals with Parkinson's. In study participants with and without Parkinson's, all-cause mortality was found to increase with domperidone exposure, indicating that the risk for all-cause mortality may not solely be attributable to mechanisms of Parkinson disease.

Limitations of the study included sample selection biases inherent to population-based studies, baseline rates of cardiovascular disease that were higher in patients with vs without Parkinson's, which predisposed the Parkinson's group to increased risk for cardiovascular complications.

“In our population-based study, current domperidone use was associated with a doubled risk of mortality in patients [with Parkinson's], which was highest at the start of domperidone treatment,” concluded the study authors.

Reference

Simeonova M, de Vries F, Pouwels S, et al. Increased risk of all-cause mortality associated with domperidone use in Parkinson patients: a population-based cohort study in the UK. [published online July 16, 2018]. British Journal of Clinical Pharmacology. doi: 10.1111/bcp.13708

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