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Domperidone for Breast Milk Supply - What's the Deal?

Updated: Oct 4, 2023

You may have heard about the prescription medication domperidone in the news lately. (If not check it out HERE, HERE, and HERE.)

Health Canada recently announced they are conducting a safety review of domperidone being used to increase milk supply in postpartum women because of case reports of withdrawal.


Let’s break it down today!



Now, I’ll start with a caveat. This is not a discussion of ‘breast is best’. I want to kick that perspective that you should provide breast milk at all costs. A lactation consultant (or other appropriate support) for the breastfeeding parent should always be involved to address latch, technique, skin-to-skin contact, etc. Assuming these strategies are not responsive, taking medication could be considered if it supports the physical, mental and emotional health of both the baby and the nursing parent. It’s a deeply individual decision!

Now, let’s dive into what we came here for, shall we?

What is domperidone?

Domperidone is a prescription medication approved in Canada to treat gastrointestinal conditions and symptoms. It is also used off-label for lactation support, to increase breast milk supply.

We know that domperidone is very commonly used for this purpose!


One study in British Columbia done in 2011 suggests that about 1 in 3 women with babies born early (preterm) and 1 in 5 women (almost 20%!) with babies born at full-term were prescribed domperidone in the first 6 months postpartum.

How does it work to help with milk production?

Domperidone works by blocking dopamine at receptors in the gut. Dopamine, in the gut?! Why yes… Dopamine in the gut actually helps to stimulate smooth muscle, the muscle surrounding your GI organs like your stomach and intestines. This helps to increase contractions that move food through the digestive tract. The drug does not cross the blood brain barrier, so therefore does not impact the dopamine in your brain.

What does dopamine in the gut have to do with breastfeeding, you ask? Well, a side effect of blocking dopamine is to increase a hormone called prolactin in the blood. Prolactin is one of the main hormones involved in breast milk production.

Does it work?

There is not a lot of research to look at ANYTHING that helps with breast milk production, whether it's medication, herbal products, or foods. So, that being said, what we know from studies about domperidone for breast milk production is limited. The majority of research has been in mothers of preterm babies and only looked at domperidone use for up to 4 weeks maximum. The most commonly studied dose is 10 mg three times daily (=30mg/day), while two trials look at double that dose, 20mg three time daily (=60mg/day). In practice we see doses up to 160mg/day!


All evidence that dose exist suggests it works. It shows an increase of out put of 100ml/day of breastmilk. Remember we are mainly look at preterm infants, mother of babies 20-37 weeks, so this is pretty good! Also, as we discussed above, we have a lot of anecdotal and clinical experience saying it helps most (although not all) nursing women.


Of the medications (and supplements, and foods) used around the world to help with breastmilk production, domperidone is the best studied to show it works.

Is it safe?

First, let’s talk about baby. You may wonder, would this drug affect my baby? Don't worry, it is safe. It does pass through breast milk but in EXTREMELY small amounts and not considered to be significant (e.g. 0.012%). In the studies that were done, there were no negative effects in babies - and remember we are talking about tiny, preterm babies here... Also, domperidone is actually used to treat some GI conditions in babies and children.

What about side effects for mom? While using it most people find it very well tolerated with little to no side effects. The most common side effects that can be experienced are headache, dry mouth, and GI disturbances.

You may also have heard about heart risk. In fact Health Canada has put out a warning about this in the past - specifically, ventricular arrhythmias (abnormal heart rhythms) and “sudden cardiac death”. Scary, right?! Well, fear not… These risks seen with domperidone are seen almost exclusively in older patients (>60 years) or people who have other risk factors. Numerous studies now provide reassurance as to the safety of domperidone in lactating women. Your doctor will assess your personal risk when prescribing the drug to ensure you do not have any additional risk factors (like a pre-existing heart condition or taking certain medications).

What about all this withdrawal stuff?!

Here’s the kicker.


Health Canada is currently conducting a safety review because of case reports of withdrawal when stopping the medication or reduce the dose. Anecdotal evidence and case reports show that women can experience serious symptoms when they come off the drug - particularly if you stop “cold turkey” or reduce the dose too fast.


Symptoms may include:

  • Increased heart rate (heart racing)

  • Heart palpitations

  • Insomnia

  • Anxiety

  • Agitation

  • Dry mouth

  • Depression

  • Panic attacks

  • Psychosis

  • Etc.

Drug studies are typically run short term, to look at effectiveness and immediate side effects or risks of the drug. As we learned above domperidone for this use has only been studied for up to 4 weeks and at lower doses than we see used in practice.


So the truth is, we don’t have a lot of research about this, despite it being SO commonly used!


The other big problem, is that domperidone withdrawal is often missed or dismissed as postpartum anxiety or depression. Even women themselves will dismiss their own symptoms as 'normal' during this time or just part of having a young baby. It's really important for women taking domperidone, and the healthcare providers caring for them, to recognize withdrawal is possible and to access support through the weaning process.

What can we do about it?

So, we know domperidone works to increase breast milk supply and while using it, it’s actually pretty safe and well tolerated. We can mitigate and avoid any withdrawal by slowly tapering off the drug when you are ready to stop.

Generally speaking, recommendations are to reduce 10 mg (or 1 pill) per WEEK.

Here is an example for someone who is taking 20 mg (2 pills) three times a day (=6 pills/day).

Week 1: 1 pill (10mg) morning + 2 pills noon + 2 pills night (=5 pills/day)

Week 2: 1 pill morning + 1 pill noon + 2 pills night (=4 pills/day)

Week 3: 1 pill morning + 1 pill noon + 1 pill night (=3 pills/day)

Week 4: 1 pill morning + 1 pill night (=2 pills/day)

Week 5: 1 pill morning (=1 pill/day)

That being said, you are an individual. Each person's experience will be different on how they tolerate this. It is possible to follow this weaning schedule and still experience withdrawal effects. Some people need to go slower, and some can actually go faster.

I have actually experienced domperidone withdrawal personally!! As a pharmacist who did my research, I knew I had to wean slowly. Even at this rate, I still experienced heart palpitations, anxiety and panic attacks. (Perhaps that’s a story for another day…)



You can make your experience a lot smoother by working with a health professional to check in at each dose reduction and provide guidance along the way. You can get off the drug safely and minimize any withdrawal effects.

We also work with people to support them in tapering off domperidone safely. We work alongside your doctor(s) and care team to give you the best experience.


Book a complimentary discovery call to learn more!




References

  1. Asztalos EV, Campbell-Yeo M, da Silva OP, Ito S, Kiss A, Knoppert D; EMPOWER Study Collaborative Group. Enhancing Human Milk Production With Domperidone in Mothers of Preterm Infants. J Hum Lact. 2017 Feb;33(1):181-187. doi: 10.1177/0890334416680176. Epub 2017 Jan 20. PMID: 28107101. Accessed at https://pubmed.ncbi.nlm.nih.gov/28107101/

  2. Donovan TJ, Buchanan K. Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants. Cochrane Database Syst Rev. 2012 Mar 14;(3):CD005544. doi: 10.1002/14651858.CD005544.pub2. PMID: 22419310. Accessed at https://pubmed.ncbi.nlm.nih.gov/22419310/

  3. Grzeskowiak LE, Wlodek ME, Geddes DT. What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?-A Narrative Review. Nutrients. 2019 Apr 28;11(5):974. doi: 10.3390/nu11050974. PMID: 31035376; PMCID: PMC6567188. Accessed at https://pubmed.ncbi.nlm.nih.gov/31035376/

  4. Smolina K, et al. Postpartum domperidone use in British Columbia: a retrospective cohort study. CMAJ. 2016 Jan 12; 4(1) E13-E19. DOI: https://doi.org/10.9778/cmajo.20150067 Accessed at https://www.cmajopen.ca/content/4/1/E13

  5. Wan EW, Davey K, Page-Sharp M, Hartmann PE, Simmer K, Ilett KF. Dose-effect study of domperidone as a galactagogue in preterm mothers with insufficient milk supply, and its transfer into milk. Br J Clin Pharmacol. 2008 Aug;66(2):283-9. doi: 10.1111/j.1365-2125.2008.03207.x. Epub 2008 Apr 21. PMID: 18507654; PMCID: PMC2492930. Accessed at https://pubmed.ncbi.nlm.nih.gov/18507654/

  6. Majdinasab E, Haque S, Stark A, Krutsch K, Hale TW. Psychiatric Manifestations of Withdrawal Following Domperidone Used as a Galactagogue. Breastfeed Med. 2022 Dec;17(12):1018-1024. doi: 10.1089/bfm.2022.0190. Epub 2022 Nov 11. PMID: 36367713. Accessed at https://pubmed.ncbi.nlm.nih.gov/36367713/

  7. Papastergiou J, Abdallah M, Tran A, Folkins C. Domperidone withdrawal in a breastfeeding woman. Can Pharm J (Ott). 2013 Jul;146(4):210-2. doi: 10.1177/1715163513492928. PMID: 23940477; PMCID: PMC3734912. Accessed at https://pubmed.ncbi.nlm.nih.gov/23940477/

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