A Randomized Comparison of Metoclopramide and Domperidone on Plasma Aldosterone Concentration and on Spironolactone–Induced Diuresis in Ascitic Cirrhotic Patients

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Abstract
The effect of metoclopramide and domperidone, two dopamine antagonists, administered to cirrhotic patients with ascites and secondary hyperaldosteronism, was examined to evaluate the changes in plasma aldosterone levels and in spironolactone–induced diuresis. In 15 patients with ascites and secondry hyperaldosteronism, the intravenous administration of 10 mg metoclopramide significantly increased plasma aldosterone levels (23%, p < 0.01). This effect was observed when an equivalent dose of domperidone was administered. In 20 ascitic patients treated with spironolactone (300 mg per day), the administration of metoclopramide (20 mg) significantly reduced urinary output (24%, p < 0.001) and urinary sodium (35%, p < 0.001) while simultaneously increasing urinary potassium (24%, p < 0.001) and plasma aldosterone (40%, p < 0.001). This effect was not observed with domperidone in an equivalent dose. Therefore, it is recommended that metoclopramide should be avoided during diuretic therapy in cirrhotic patients with ascites. In these circumstances, domperidone is preferred.