Home
> Breastfeeding
> Jack Newman's Breastfeeding
Handouts
Domperidone - 1
Handout #19a. Domperidone. January 2005
Written by Jack Newman, MD, FRCPC. © 2005
Introduction
Domperidone (Motilium™) is a drug that has, as a side effect,
the increasing of milk production, probably by increasing prolactin
production by the pituitary gland. Prolactin is the hormone that
stimulates the cells in the mother's breast to produce milk. Domperidone
increases prolactin secretion indirectly, by interfering with the
action of dopamine, whose action is to decrease the secretion of
prolactin by the pituitary gland. Domperidone is generally used
for disorders of the gastrointestinal tract (gut) and has not been
released in Canada for use as a stimulant for milk production. This
does not mean that it cannot be prescribed for this reason, but
rather that the manufacturer does not back its use for increasing
milk production. However, there are several studies that show that
it works to increase milk production and that it is safe. It has
been used, for several years, in small infants who spit up and lose
weight, but was replaced until a few years ago by cisapride (Prepulsid™)
(cisapride has since been taken off the market because it can cause
serious cardiac problems). Domperidone is not in the same
family of medication as cisapride. Another, related, but
older medication, metoclopramide (Maxeran™), is also known
to increase milk production, but it has frequent side effects which
have made its use for many nursing mothers unacceptable (fatigue,
irritability, depression). Domperidone has many fewer side effects
because it does not enter the brain tissue in significant amounts
(does not pass the blood-brain barrier).
In June of 2004, the Federal Drug Administration (FDA) in the US
put out a warning against using domperidone because of possible
cardiac side effects. This unfortunate step was taken without considering
the fact that the cardiac side effects occurred only when the drug
was taken intravenously by otherwise very sick patients. In all
the years I have used domperidone in so many mothers, I have not
yet heard of any significant cardiac side effects that could be
attributed to domperidone. Incidentally, the Federal Drug Administration
has no authority outside the US, and even in the US, compounding
pharmacies, who are not regulated by the FDA, are continuing to
provide patients with domperidone.
When is it appropriate to use domperidone?
Domperidone must never be used as the first approach
to correcting breastfeeding difficulties. Domperidone is not
a cure for all things. It must not be used unless
all other factors that may result in insufficient milk
supply have been dealt with first. (See handout: Protocol
to increase breastmilk intake by the baby). What can be done?
- Correct the baby's
latch so that the baby can obtain as efficiently as possible
the milk which the mother has available. Correcting the latch
may be all that is necessary to change a situation of "not
enough milk" to one of "plenty of milk".
- Use breast compression to increase the intake of milk (handout
#15, Breast
Compression).
- Use milk expression after feedings to increase the supply.
- Correct sucking problems, stopping the use of artificial nipples
(handout #5, Using
a Lactation Aid, and #8, Finger
Feeding) and other stratagems.
Using domperidone for increasing milk production
Domperidone works particularly well to increase milk production
under the following circumstances:
- It has frequently been noted that a mother who is pumping milk
for a sick or premature baby in hospital has a decrease in the
amount she pumps around four or five weeks after the baby is born.
The reasons for this decrease are likely many, but domperidone
generally brings the amount of milk pumped back to where it was
or even to higher levels.
- When a mother has a decrease in milk supply, often associated
with the use of birth control pills (avoid œstrogen containing
birth control pills while breastfeeding), or on occasion, for
no obvious reason when the baby is three or four months old, domperidone
will often bring the supply back to normal. See the handout #25,
Slow Weight Gain After the First Few Months for reasons
milk supply might decrease and fix what can be fixed.
Domperidone still works, but often less dramatically when:
- The mother is pumping for a sick or premature baby but has not
managed to develop a full milk supply.
- The mother is trying to develop a full milk supply while nursing
an adopted baby.
- The mother is trying to wean the baby from supplements.
Side effects of domperidone
As with all medications, side effects are possible, and many have
been reported with domperidone (textbooks often list any side effect
ever reported, but symptoms reported are not necessarily due to
the drug a person is taking). There is no such thing as
a 100% safe drug. However, our clinical experience has
been that side effects in the mother are extremely uncommon, except
for increasing milk supply. Some side effects which mothers we have
treated have reported (very uncommonly, incidentally):
- headache which disappeared when the dose was reduced (probably
the most common side effect)
- abdominal cramps
- dry mouth
- alteration of menstrual periods
The amount that gets into the milk is so tiny that side effects
in the baby should not be expected. Mothers have not reported any
to us, in many years of use. Certainly the amount the baby gets
through the milk is a tiny percentage of what babies would
get if being treated for spitting up.
Are there long term concerns about the use of domperidone?
The manufacturer states in its literature that chronic
treatment with domperidone in rodents has resulted in increased
numbers of breast tumours in the rodents. The literature goes on
to state that this has never been documented in humans. Note that
toxicity studies of medication usually require treatment with huge
doses over periods of time involving most or all of the animal's
lifetime. Note also that not breastfeeding increases the
risk of breast cancer, and breast cancer risk decreases the longer
you breastfeed.
Using Domperidone
Generally, we now start domperidone at 30 mg (three 10 mg tablets)
3 times a day. In some situations we go as high as 40 mg 4 times
a day. Printouts from the pharmacy often suggest taking domperidone
30 minutes before eating, but that is because of its use for digestive
intolerance. You can take the domperidone about every 8 hours, when
it is convenient (there is no need to wake up to keep to an 8 hour
schedule—it does not make any difference). Most mothers take
the domperidone for 3 to 8 weeks, but sometimes it is needed longer
than that, and sometimes it is impossible for mothers to maintain
their milk supply without staying on domperidone. Mothers who are
nursing adopted babies may have to take the drug much longer. People
taking domperidone for stomach disorders are often taking it for
many years.
After starting domperidone, it may take three or four days before
you notice any effect, though sometimes mothers notice an effect
within 24 hours. It appears to take two to three weeks to get a
maximum effect, but some mothers have noted effects only after 4
or more weeks. It is reasonable to give domperidone a trial of at
least four, and better, six weeks before saying it doesn’t
work.
For more information on how to wean off the domperidone see the
handout: Domperidone
2.
Questions?
see
my book Dr. Jack Newman's Guide to Breastfeeding (called
The
Ultimate Breastfeeding Book of Answers in the USA)
Handout #19a. Domperidone. January 2005
Written by Jack Newman, MD, FRCPC. © 2005
This
handout may be copied and distributed without further permission,
on
the condition that it is not used in any context in which
the WHO code on the marketing of breastmilk substitutes is violated
