Mailed Prescriptions From Canada After October 22nd and the FDA Path Left for Domperidone

Domperidone, a stomach-emptying medicine that Canadian doctors prescribe for gastroparesis and that the FDA has never approved, is about to become much harder for Americans to get. From October 22nd, 2026, mailed packages holding FDA-regulated products must go through formal customs entry or a new electronic entry CBP is testing, and the Canadian International Pharmacy Association (CIPA) expects virtually all routine personal prescription orders mailed from Canada to stop reaching U.S. patients. The warning comes a year after the FDA said its own domperidone program would lose its only supplier at the end of September 2025. Those are 2 separate changes. The FDA program was the formal U.S. route, through a doctor's application and a U.S. dispensing pharmacy, while orders mailed from Canadian pharmacies were never part of it and kept arriving after it ended, and those mail orders are what the October 22nd change affects.

What Changes on October 22nd for Prescriptions Mailed From Canada

On October 22nd, 2026, mailed packages carrying products that another federal agency regulates, which includes every prescription drug, can no longer use the simpler postal customs process and must go through formal entry or a new electronic entry called Entry Type 13. The requirement comes from an interim final rule that U.S. Customs and Border Protection (CBP) published on June 24, 2026. The duty-free de minimis exemption for imports valued at $800 or less had been suspended since August 2025, and the rule made that suspension indefinite for mail (CBP, Federal Register).

Both routes need an importer of record, the party customs holds legally responsible for a package, and STAT reported that the process requires a licensed customs broker and an entry bond, a financial guarantee. CIPA says Zonos, the company that acts as customs broker for nearly all major international postal systems, will be prevented from serving as importer of record for shipments of a drug that is commercially available in the United States. In CIPA's assessment, that covers virtually the whole market for mailed personal prescriptions.

The rule does not single out prescription medicines and does not ban personal imports. CBP says the change protects revenue and helps prevent unlawful importation, and the lawmakers who wrote to the agencies said they support CBP's goal of using better data to intercept high-risk shipments while asking for clear assurances that genuine prescriptions for personal use will not be refused. Their announcement estimates that 2.3 million Americans get lower-cost medicines from Canada and other countries this way.

Domperidone is not approved by the FDA for any use in humans, and the FDA says it cannot legally be compounded. In 2004 the agency warned that distributing domperidone for human use is illegal, citing the risk of irregular heart rhythms, cardiac arrest and sudden death, and on June 7, 2004 it issued an import alert advising field staff that they may detain shipments containing domperidone (FDA IND packet, 2021). Mail-order domperidone has therefore always depended on the FDA choosing not to act, never on a legal right.

Canada treats domperidone as a regular prescription medicine. Health Canada approves prescription domperidone for upper gastrointestinal motility problems, including diabetic gastroparesis, and its January 2015 safety review, which covered the brand product and 13 generics, set the maximum recommended dose at 30 mg a day because of heart rhythm risks (Health Canada).

For Americans, the lawful route ran through FDA expanded access. A doctor could file an investigational new drug application for a patient 12 or older with gastroparesis, reflux with upper GI symptoms or chronic constipation who had not improved on standard treatment, and 1 supplier shipped the tablets. The FDA says it learned in late 2022 that the supplier was leaving the business after the product's ownership moved to another company, warned doctors in December 2024, and confirmed that distribution would end after September 2025, after efforts to find a replacement were unsuccessful (FDA).

The FDA Expanded Access Route Doctors Can Still Use for Domperidone

A doctor can still request domperidone through FDA expanded access by finding a new supplier and filing a new application, according to the FDA's August 4, 2025 update. If that supplier ships from outside the United States, the doctor acting as physician-sponsor must meet the FDA's import rule for investigational drugs, 21 CFR 312.110(a), a separate path from a personal mail order (FDA).

The FDA says it remains available to help once a supplier is identified. A doctor treating 1 patient can use the single-patient form, FDA Form 3926, in place of the longer application forms, and the FDA's Office of Drug Information takes questions at 855-543-3784 or druginfo@fda.hhs.gov. Our guide to compassionate use explains how an expanded access request moves through the FDA.

Children's Mercy Hospital in Kansas City registers a domperidone compassionate-use program for patients ages 12 to 21, listed as recruiting on ClinicalTrials.gov (NCT04699591, last updated March 24, 2026). One reading of that listing is that at least 1 U.S. center still has a way to obtain the drug, though registry status can lag behind what a program is actually doing, and a doctor searching for a supplier can ask the team how theirs is sourced.

What Domperidone's Supply Gap Means for Rare Disease Families on Unapproved Drugs

Domperidone shows that FDA expanded access works only while a company is willing to supply the drug. When the only supplier left, every patient in the program lost access at once, with no FDA decision against the drug itself. Families who depend on compassionate use for a rare disease medicine carry the same exposure, and a backup plan agreed with the treating doctor is easier to make before a supplier change than after.

The October 22nd change also affects an FDA policy written for situations common in rare disease. The FDA says it may allow personal imports of an unapproved drug for a serious condition when effective treatment may not be available in the United States, there is no promotion of the product to U.S. residents, the product carries no unreasonable risk, the patient affirms personal use in writing, and the supply is generally no more than 3 months, with a U.S. doctor named or proof that treatment began abroad (FDA). That policy is discretion rather than a right, and it now sits alongside formal customs entry for every mailed drug.

CIPA's warning centers on drugs sold commercially in the United States, and domperidone is not one of them. That does not make domperidone easier to mail, because the FDA lists products on an import alert among the personal imports it refuses, and domperidone has been under one since 2004 (FDA).

Severe stomach and gut motility problems run through several rare diseases. A 2024 study of people with systemic sclerosis described metoclopramide and domperidone as commonly used prokinetic medicines, and gastrointestinal dysmotility is common in Rett syndrome and a common, serious feature of hereditary ATTR amyloidosis. A 2025 American Gastroenterological Association update says abnormal gastric emptying may be more common in people with hypermobile Ehlers-Danlos syndrome who also have POTS and upper GI symptoms, and MNGIE, a rare mitochondrial disease, is marked by severe gastrointestinal dysmotility (PubMed sources below).

Gastroparesis Treatments You Can Get in the United States Without Importing

Metoclopramide is the only FDA-approved drug therapy for gastroparesis, according to a 2026 review in Neurogastroenterology and Motility, and the Reglan tablet label covers acute and recurrent diabetic gastroparesis in adults. That label carries a boxed warning for tardive dyskinesia, a movement disorder that can be irreversible, and tells prescribers to avoid treatment longer than 12 weeks (DailyMed).

In the United States, the largest recent evidence for domperidone is observational. In a cohort of 748 patients followed by the NIDDK Gastroparesis Clinical Research Consortium, the 181 who started domperidone had moderate but statistically significant symptom improvement compared with those who did not (Clinical Gastroenterology and Hepatology, 2022).

A modified form called deudomperidone (CIN-102) finished 2 Phase 2 gastroparesis trials with 382 and 416 participants, and CinDome Pharma said in March 2026 that topline results from the second trial, envisionGI, are expected in late 2026. Apart from an adult expanded access listing in Philadelphia for people with cancer and gastroparesis (NCT02494687) that has not been updated since 2020, a ClinicalTrials.gov search on October 13, 2026 found no domperidone-like drug enrolling adults at a U.S. site.

Eliquis, Xarelto and TrumpRx for People Who Import U.S.-Approved Drugs

We did not find Eliquis (apixaban) on TrumpRx.gov when we checked on October 13, 2026, so people who imported Eliquis from Canada to save money will not find a TrumpRx price for it. Bristol Myers Squibb's own direct-to-patient program sells a 30-day supply for $345 to eligible adults (BMS).

That BMS program is for people who are uninsured, whose insurance does not cover Eliquis, or whose insurance would cost more than $345. It excludes people in Medicare Part D or Medicare Advantage drug plans, and payments do not count toward deductibles (BMS program terms). Mark Cuban Cost Plus Drug Company has sold Eliquis at the same $345 for 30 days since April 27, 2026, and the companies have said generic apixaban cannot launch before April 1, 2028, a date set by a 2021 court decision that they noted was subject to further appeals (BMS-Pfizer Alliance, 2021). Mark Cuban Cost Plus pricing is from BMS's April 2026 announcement.

TrumpRx does list Xarelto (rivaroxaban), another blood thinner, starting at $197 through Johnson & Johnson's direct program, J&J Direct, against a crossed-out $611.82 (TrumpRx). The site launched on February 5, 2026 with 40 brand-name drugs and added more than 600 generics in May, according to the White House, and drug pages say the price is out of pocket and that insured people should check their copay first.

At least 1 rare disease medicine is listed. Rydapt (midostaurin), which its FDA label lists for advanced systemic mastocytosis and a form of acute myeloid leukemia, shows a starting price of $2,908.64 against a crossed-out $13,411. Domperidone, which is not FDA-approved, is not on TrumpRx.

Questions to Ask Your Doctor or Pharmacy About Domperidone Before October 22nd

Ask the pharmacy whether an order placed now will clear U.S. customs before October 22nd, and what it plans to do with orders after that date. Ask the prescriber whether they, or the hospital's research pharmacy, would sponsor a new expanded access application if a supplier can be found, and whether a referral to a gastrointestinal motility center makes sense.

Ask, too, how to stop safely if the supply runs out. The FDA reported agitation, anxiety, insomnia and other psychiatric symptoms in people who stopped or tapered domperidone they had taken to increase breast milk. Those cases involved a different use, but they are a reason to plan any change with a doctor rather than run out without warning (FDA).