A case of sudden cardiac death following Domperidone self-medication. (September 2015)

• Record Type: Journal Article
• Authors: Fais, Paolo; Vermiglio, Elisa; Laposata, Chiara; Lockwood, Robert; Gottardo, Rossella; De Leo, Domenico
• Is Part Of: Forensic science international. Volume 254(2015)
• Page Start: e1
• Page End: e3
• Publication Date: 2015-09
• Subjects: Domperidone -- Sudden cardiac death -- Autopsy -- Long QT; Medical jurisprudence -- Periodicals; Chemistry, Forensic -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Chimie légale -- Périodiques; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; Chemistry, Forensic; Medical jurisprudence; Electronic journals; Periodicals; Electronic journals; 614.1
• DOI: 10.1016/j.forsciint.2015.06.004
• Languages: English
• ISSNs: 0379-0738

Abstract

Highlights: Domperidone is used for gastroesophageal reflux and functional dyspepsia. Domperidone is also used as an off-label drug for stimulating lactation. Domperidone is available as an over-the-counter (OTC) drug in many countries. Its therapeutic window is narrow (safety index of only 2.5). Its administration is related to an increased risk of sudden cardiac death. Abstract: The phenomenon of sudden cardiac death is usually related to the worsening of existing heart conditions leading to ventricular arrhythmia (VA). One of the well-known triggers of SCD is drug-induced prolongation of the QT interval, such as that caused by Domperidone (D). Despite its risk to prolong the QT interval and associated narrow therapeutic index, D is available as an over-the-counter (OTC) drug in many countries such as Italy, Ireland, Netherlands, China, South Africa, Mexico, New Zealand and Chile to treat gastroesophageal reflux and functional dyspepsia. The present paper reports a case of SCD that occurred some hours after D self-administration in a 47-year-old female subject with mitral valve prolapse, thus, predisposed to both VA and SCD. Despite the risks related to D administration, to the best of our knowledge, this particular issue has not been discussed in the medico-legal literature. For this reason, the forensic implications of D administration are discussed focusing on issues related to the self-administration as an OTC drug (as seen in this case), administration to incapacitated subjects, prescription to patients with contraindications and the off-label drug use of D at high and hazardous concentrations to stimulate lactation.