Motilium in renal failure

Ortho-Janssen has updated its monograph to caution the use of Motilium in patients with severe renal insufficiency. They are recommending the dosing interval be changed to daily-bid. This is based on pharmacokinetic evidence showing the half-life is extended to 20.8hrs in RF (7.4hrs without RF). They really have no concrete studies from what I gather. I was referred to the product monograph to see what adverse events we could expect. So I guess that we must consider side effects such as gynecomastia, galactorrhea, EPS, drowsiness, disorientation, arrhythmias and hypotension could be due to domperidone accumulation.