Using domperidone for increasing milk production:[Pediatrics Guide Update: The FDA is now warning against the use of Domperidone. In response to reports that women may be using an unapproved drug, domperidone, to increase milk production (lactation), the Food and Drug Administration (FDA) is warning breastfeeding women not to use this product because of safety concerns.
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 4 or 5 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 Åstrogen containing birth control pills while breastfeeding), or on occasion, for no obvious reason when the baby is 3 or 4 months old, domperidone will often bring the supply back to normal.
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
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.
Generally, we start domperidone at 20 milligrammes (two 10 mg tablets) four times a day. If taking domperidone 4 times a day is inconvenient, 30 milligrammes (three 10 mg tablets) three times a day is fine. 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 6 hours, when it is convenient (there is no need to wake up to keep to a 6 hour scheduleâit does not make any difference). Most mothers take the domperidone for 3 to 8 weeks. Mothers who are nursing adopted babies may have to take the drug much longer.
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.
[Pediatrics Guide Update: The FDA is now warning against the use of Domperidone. In response to reports that women may be using an unapproved drug, domperidone, to increase milk production (lactation), the Food and Drug Administration (FDA) is warning breastfeeding women not to use this product because of safety concerns. read more about the FDA warning]
Revised January 2000
Written by Jack Newman, MD, FRCPC
Used with permission.