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Domperidone - 2
Handout #19b. Domperidone-2. January 2005
Written by Jack Newman, MD, FRCPC. © 2005
How long can I use domperidone?
When domperidone was being used for babies (and now that cisapride
is off the market, it is being used again), it was common for the
babies to be on the medication for several months. Since the amount
of domperidone that gets into the milk is very small indeed, from
the baby’s point of view, there should be no issue in the
mother taking it to increase milk supply for several months. Our
experience with this drug is that short-term side effects are very
few and almost always very mild. Worldwide experience with domperidone
over at least two decades suggests that long-term side effects also
are rare. Some of the mothers in our clinic, breastfeeding adopted
babies, have been on the medication for 18 months without any apparent
side effects. As mentioned in handout #19a Domperidone-1,
patients using domperidone for stomach disorders may be on it for
many years. I hope you won’t need domperidone for very long,
but if it’s necessary and helpful, stay on it.
How long does it take for domperidone to work?
It depends on the situation. In a situation where the mother had
had a good milk supply, but it decreased for some reason (e.g.
going on the birth control pill, see handout #25 Slow
Weight Gain After the First Few Months), domperidone often
works very rapidly to increase the milk supply. Often, within a
day or two the mother is seeing a difference (and so does her baby).
But this is not always so, and in many situations, it may take a
week or more for the mother to start getting an effect. On occasion,
we have had mothers only starting to get an increase in their milk
supplies a month or more after starting to take it. Therefore, we
generally recommended that the mother take the domperidone for at
least six weeks in order to be sure whether it has worked or not.
It is our impression that domperidone works best after the first
few weeks after the mother has given birth (usually after about
four weeks). This has not been proved, but there are theoretical
reasons why it may be so. For this reason, we have often waited
to prescribe it until the baby is at least three weeks, mainly
because we did not want the mother to become discouraged if she
did not see any rapid increase in her milk supply. But if you keep
this in mind, I have no problem prescribing it before four weeks
after the birth of the baby.
How do I know how long to take domperidone?
Usually, we ask the mother take it for two weeks and then re-evaluate
the situation. There are several possibilities.
- The milk supply has increased substantially, to the point where
there is no longer a consideration of using supplements, or the
mother has been able to stop supplements with the baby continuing
to gain well on breastfeeding alone.
- The milk supply has increased to a point that the mother feels
is satisfactory. For example, she may still need to supplement,
but the baby does not fuss any more at the breast and drinks contentedly.
- There has been little or no effect with the Protocol
to Increase Breastmilk Intake by the Baby and the domperidone.
Often waiting or increasing the dose may help.
In the first situation (but not necessarily always in that situation),
we may suggest the mother start weaning herself from the domperidone
in this way:
- Most mothers are taking three tablets three times a day. When
you are ready to start weaning from the domperidone, drop one
pill, so that now, instead of nine pills a day, you will be taking
eight.
- Wait four or five days, a week if you wish. If you see no change
in your milk supply, drop another pill.
- Wait another four or five days. If you see no change in your
milk supply, drop another pill.
- Continue in this way until you are down to no pills a day. If
there has been no decrease in your milk supply, or if there has
been a small decrease that does not affect the breastfeeding and
baby’s weight gain, that’s just what we hope to have
happened, and many mothers manage this.
- If, however, your supply diminishes significantly, return to
the previous effective dose and do not drop any pills for a couple
of weeks at least.
- If you are keen to go off the domperidone, after a couple of
weeks on the same dose, start dropping a pill a day, as in step
1 above. Some mothers, who were not able to get off the domperidone
with steps 1-4 above the first time, can do it the second or the
third time.
- You may find that you have to continue a certain dose to maintain
your milk supply. But following steps 1-4 above will get you to
the lowest effective dose.
It is possible, however, that after two weeks, you are not where
you want to be. In that case, you should continue using the domperidone.
If you are still not where you want to be after six weeks of domperidone,
it is time to think some more about the domperidone. If you are
supplementing, and have managed to reduce the amount of supplement
from 14 ounces to 10 ounces, is it really worth taking a drug in
order to do this? If you feel it is, then continue with the domperidone,
but try weaning the number of pills down to minimum number that
maintain your milk supply, as above. If you do not feel it is worth
it, try weaning down as above, and if you don’t see any change
once you get to no pills a day, fine. However, if you do notice
a real change in the milk supply as you lower the dose, maybe the
domperidone is more effective than you had thought (remember, after
six weeks, your baby is significantly heavier, and it may be that
instead of needing 14 ounces without domperidone, the baby might
actually need 20 ounces to maintain good weight gain, in which case
the domperidone is actually doing something).
Remember: Before using domperidone, the breastfeeding should
be fixed, and as quickly as possible. This means:
For more information on domperidone see the handout: Domperidone
- 1.
See the handout Protocol
to Increase Breastmilk Intake by the Baby, and handout
#25, Slow
Weight Gain After the First Few Months. See also the website
www.thebirthden.com/Newman.html
for videos on how to latch a baby on, how to know the baby is getting
milk, how to use compression and how to use a lactation aid.
Questions?
see
my book Dr. Jack Newman's Guide to Breastfeeding (called
The
Ultimate Breastfeeding Book of Answers in the USA)
Handout #19b. Domperidone-2. 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
