Motilium alternatives — what to try when domperidone isn't right

Motilium is the brand name for domperidone, a prokinetic often used for nausea, gastroparesis and sometimes to boost milk supply. People look for alternatives when domperidone is unavailable, causes side effects, or isn't safe because of heart risks. Below are clear, practical options — what they do, their trade-offs, and when to check with a doctor.

Drug alternatives: pros and cons

Metoclopramide (Reglan) acts like domperidone to speed stomach emptying and reduce nausea. It works well short-term, but long-term use can cause neurological side effects (tardive dyskinesia) and fatigue. Doctors usually limit treatment duration and recommend regular reviews.

Erythromycin, an antibiotic, can stimulate gastric motility by acting on motilin receptors. It helps quickly in some cases of gastroparesis, but benefits fade with time (tachyphylaxis). It may interact with other medicines and can upset digestion.

Prucalopride is a newer drug approved for chronic constipation but shows promise for improving gastric emptying in some studies. It’s not universally used yet for gastroparesis, so availability and prescriber experience vary.

Ondansetron and other antiemetics reduce nausea but don’t reliably improve motility. They can be useful if vomiting is your main problem and motility drugs are unsuitable. Note: ondansetron also carries a small QT interval risk in some patients.

Avoid older options like cisapride — it was effective but withdrawn in many countries because of serious heart rhythm problems.

Non-drug options and safety tips

Small practical changes often help. Try smaller, more frequent meals, avoid high-fat and high-fiber foods that slow digestion, and favor liquids or pureed meals when symptoms are bad. Controlling blood sugar tightly helps if you have diabetes-related gastroparesis.

For breastfeeding and milk supply: metoclopramide can raise prolactin but comes with more side effects than domperidone. Many people try herbal galactagogues first (fenugreek, blessed thistle) though evidence is mixed. Talk to your midwife or lactation consultant before starting herbs or medicines.

When medicines aren’t enough, other options include gastric electrical stimulation, botulinum toxin to the pylorus, or surgical procedures — these are for severe, persistent cases and need specialist review.

Safety first: domperidone and some alternatives can affect heart rhythms or cause neurological issues. Tell your doctor about other drugs you take, existing heart conditions, and pregnancy or breastfeeding. If you get fainting, racing heartbeat, severe abdominal pain, high fever, or blood in vomit or stool, seek urgent care.

Want help deciding? Ask your doctor or a gastroenterologist to match the treatment to the cause of your symptoms, your medical history, and your priorities (short-term relief vs long-term safety). A tailored plan usually works better than guessing.