Confused about drug interactions

[Sophabulous]

Hi all,

This morning I went to see a GP about the ridiculous nausea I experience. He has prescribed me Motileum or domperidone is the unbranded name. I have a few queries now that I've actually picked up the prescription.

He did explain that domperidone has been implicated in some cases of sudden heart failure, however concluded that the risk in my case was minimal. That's fine, but I forgot to mention at the time that my resting heart rate is always abnormally high? I have an appointment at the hospital on Thursday so this can wait until then, but I would be interested to hear experiences/opinions?

Secondly he mentioned that this medication interacts with the esomeprazole I take at 40mg in the morning. Instead he has substituted this for rabeprazole 20mg once a day which apparently is fine to take with the domperidone.

My question being, is this a lower but potentially safer dose of the esomeprazole or is it equivalent? I only ask because I was in omeprazole 20mg for months with no improvement whatsoever. If rabeprazole is a step down then I would like to know before I take the plunge. I found a big difference between omeprazole and esomeprazole so I don't want to take a step or 5 back!

Thanks in advance!

 

[ronroush7]

Just my opinion but since your resting heart rate is unusually high, I would tell your doctor about this and then ask if he still wants you to start this medicine or try something else.

 

[Maya142]

My daughter is also on Domperidone for Gastroparesis. She actually also has a high heart rate and is at risk for heart issues, due to her AS. Sheis followed closely by a cardiologist, who has allowed Domperidone and she has an EKG and an echocardiogram done twice a year to monitor.

It has worked very well for her. She went from being very nauseous after every meal to minor nausea (unless she eats something she knows she shouldn't).

She is actually also on rabeprazole for reflux. I don't know if it's equivalent to the dose of esomeprazole that you were on though. It works ok for her - she also takes Pepcid and Carafate, but she has pretty severe reflux and is on lots of other medications that cause stomach issues.

Good luck!

 

[Scipio]

According to research (linked below) esomeprazole is a little stronger in its anti-acid effects than rabeprazole, and rabeprazole is in turn stronger than omeprazole. So between the two PPIs that you have tried (one that works and one that doesn't), rabeprazole falls somewhere in between.

So I can only say go ahead and try the rabeprazole your doctor has prescribed and see what happens. Perhaps it is strong enough to do the trick. It's certainly better than risking sudden heart failure by staying on the esomeprazole.

https://www.ncbi.nlm.nih.gov/pubmed/22324425

https://www.ncbi.nlm.nih.gov/pubmed/9726393

 

[Jabee]

Esomeprazole and omeprazole are very similar drugs, almost mirror images of one another. That doesn't mean they should both be equally effective; some people respond better to one than another. Esomeprazole worked better for me than omeprazole for a number of years. At some point it became less effective and my GI switched me to dexlansoprazole (Dexilant) which is working better for me. I don't know anything about rabeprazole. I actually take reglan (metaclopromide) for nausea and dysmotility and dexilant for reflux and have had no difficulties while taking both. If you find rabeprazole isn't working perhaps you could switch the domperidone to reglan or compazine, both of which work well for nausea, and go back to the esomeprazole. Nausea can be awful; I hope yours subsides.

 

[Sophabulous]

Thanks all, feeling much more clued up now! I will just mention my heart rate at the hospital tomorrow before I start taking it and hopefully they can quickly check it and give me the go ahead.

I'm pretty sure my heart rate is only high because of inflammation anyway. 10 years ago I could barely feel my pulse, this is only a recent thing and it has come down slightly since my iron levels have come back to normal.

Thanks again all!