Pharmacies sold products containing domperidone despite warnings

Almost half of the pharmacies visited by a mystery shopper wrongly sold a popular over-the-counter stomach remedy in breach of warnings that they are dangerous for people with heart conditions.

Of 93 pharmacies visited in the exercise last December, 46% sold products containing domperidone, most often seen in Ireland in the form of Motilium, despite being told the purchase was for a patient who was on heart tablets.

The figure was better than a year earlier, when 50 pharmacies were visited and 78% of them wrongly sold the drug but the Pharmacy Regulator has expressed concern at the continuing high level of breaches.

Medical authorities worldwide imposed restrictions on the sale of domperidone in 2014 following concerns that it had caused deaths in people with heart problems.

The drug is used to relieve nausea and vomiting and is helpful for people left feeling ill by strong medications taken for other complaints.

Patient information leaflets now specifically state, however, that the drug should not be taken by anyone on medication for heart conditions or high blood pressure.

One of the three warnings now carried on the patient leaflet states: “Domperidone may be associated with an increased risk of heart rhythm disorder and cardiac arrest.”

It says the risk may be higher in people over 60 years old or in those taking doses higher than the recommended limit of 30mg per day — which usually means one tablet three times a day.

In some countries, the drug is now available by prescription only, and in Ireland it is meant to be stored behind the counter so customers must engage with a staff member while buying it.

Problems highlighted by the mystery shopper exercise were the failure of some pharmacies to remove the drug from the general shop floor and the failure of others to ask any questions of the person requesting the drug.

Where questions were asked, the mystery shopper said the drug was for their partner who was over 60, suffering bloating and nausea and on heart tablets.

The Pharmaceutical Society of Ireland, the profession’s regulator, said: “On the basis of this scenario, domperidone is not a suitable medicine for this patient and a sale should not be carried out.”

However, out of the 93 pharmacies tested, 43 either sold the drug without questioning the shopper or sold it despite the details provided to them.

The regulator said: “The results of the test purchase exercise continue to be of concern to the Pharmaceutical Society of Ireland when non-prescription domperidone-containing products are sold contrary to the marketing authorisation for domperidone and Pharmaceutical Society of Ireland guidance.”

The regulator is contacting all the pharmacies involved and is to carry further ‘mystery shopper’ exercises to check if compliance rates are improving.


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