Domperidone use in Parkinson’ Disease and the risk of serious cardiac events
Domperidone is a medication used to treat nausea, vomiting and dyspepsia. It is also used in patients with Parkinson’s disease for the management of digestive symptoms associated with antiparkinsonian medications. There has been concern, however, that use of domperidone may increase the risk of serious cardiac events. Studies examining the risk of ventricular tachyarrhythmia and sudden cardiac death (VT/SCD) associated with domperidone use have been conducted in the general population; this CNODES study examined the risk of VT/SCD among patients with Parkinson’s disease.
Administrative data from seven Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, Quebec and Saskatchewan) and one international database (United Kingdom Clinical Practice Research Datalink) were used to conduct this study. Using a common protocol, each site formed a cohort of patients, of at least 50 of age, with a first diagnosis of Parkinson’s disease or a first prescription for an antiparkinsonian drug, between January 1, 1990 and June 30, 2012.
Within each cohort, a nested case-control analysis was used, with each case of VT/SCD being matched to up to 30 controls. Incidence rate ratios (RRs) associated with current use of domperidone compared to non –use were estimated using conditional logistic regression, with adjustment for potential confounders. Site-specific results were combined using meta-analytic methods.
A total of 214,962 patients newly-diagnosed with Parkinson’s disease were included in this study. Throughout 886,581 person-years of follow-up, 2,907 cases of VT/SCD were identified (resulting in an incidence rate of 3.28 per 1000 person-years). Current use of domperidone was associated with a 22% increased risk of VT/SCD nearly reaching statistical significance (adjusted RR = 1.22; 95% CI = 0.99, 1.50) compared to non-use; among those with a history of vascular disease, current use was associated with a statistically significant 38% increased risk (adjusted RR = 1.38; 95% CI = 1.07, 1.78).
The results of this large international study indicate that the risk of VT/SCD may be increased in patients with Parkinson’s disease using domperidone. Those with a history of cardiovascular disease may particularly be at an increased risk. These findings should be taken into consideration when deciding the course of management in this population.
- Tanvir Chowdhury TurinAlberta
- Colin DormuthBritish Columbia
- Pierre ErnstCPRD
- Shawn BugdenManitoba
- Hala TamimNova Scotia
- Connie MarrasOntario
- Lucie BlaisQuebec
- Charity EvansSaskatchewan
- Gary TeareSaskatchewan
- James ZhangAlberta
- Zhihai MaAlberta
- Richard MorrowBritish Columbia
- Sophie Dell'AnielloCPRD
- Matthew DahlManitoba
- Steve DoucetteNova Scotia
- Yan WangNova Scotia
- Fangyun WuOntario
- Amélie ForgetQuebec
- Xinya LuSaskatchewan