Mechanism for the gastrokinetic action of domperidone. In vitro studies in guinea pigs.

To test the hypothesis that domperidone stimulates gastric muscle contraction by antagonizing the inhibitory effects of dopamine on postsynaptic cholinergic neurons in the myenteric plexus, the effects of dopamine on circular muscle from the body of the guinea pig stomach were examined. Dopamine inhibited circular muscle contraction evoked by electric field stimulation in a dose-related manner. The threshold dose was 10(-6) mol/L and half-maximal inhibition occurred at 10(-5) mol/L. Preincubation of muscle contraction with atropine or tetrodotoxin abolished the contractile response to electric field stimulation, indicating mediation via a cholinergic pathway. The adrenergic antagonists phentolamine and propranolol and the DA1 antagonist SCH 23390 were ineffective in antagonizing the action of dopamine. In contrast, the DA2 antagonist domperidone blocked the inhibitory effect of dopamine on electric field stimulation-mediated contractions. Schild analysis showed a Ki of 3 x 10(-8) mol/L and a slope of unity. In addition, it was shown that dopamine inhibited veratridine-evoked release of [3H]acetylcholine from the gastric myenteric plexus in a dose-related manner (median effective dose, 5.2 x 10(-5) mol/L). Tetrodotoxin abolished [3H]acetylcholine release evoked by veratridine, but hexamethonium had no effect. Domperidone, but not SCH 23390, antagonized the inhibitory action of dopamine. Pretreatment with pertussis toxin blocked the action of dopamine to inhibit evoked release of [3H]acetylcholine. These observations indicate that dopamine inhibits gastric muscle contraction evoked by electric field stimulation by inhibiting cholinergic transmission. This is mediated by DA2 receptors located on the postganglionic cholinergic neurons, and the pathway involves a pertussis toxin-sensitive G protein. The DA2-receptor antagonist domperidone antagonizes the inhibitory effect of dopamine, resulting in stimulation of gastric muscle contraction. This provides a mechanism for the gastrokinetic effect of domperidone.