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Physical Methods | Medicinal Methods (Galactagogues)

Domperidone
(Motillium™)

See "Is Domperidone Safe and Can it be Obtained Legally in the US?"

How to Obtain Domperidone

Domperidone, brand name Motilium™, is a prescription anti-nausea and motility (stomach emptying) drug that is generally used for adult and pediatric gastrointestinal disorders, but which has been clinically and anecdotally shown to also have a dramatic effect upon milk production. (1), (2), (3), (4), (5), (6)   It achieves this effect by suppressing the neurotransmitter dopamine, which is a prolactin inhibitor.  As a result, serum (blood) prolactin levels increase and stimulate more milk production.

Domperidone works very similarly to metoclopramide, but with one advantage: it does not penetrate the blood-brain barrier very well and so does not carry the same central nervous system risks of depression or involuntary body movements that may occur with metoclopramide.(7)  For this reason, it is considered the drug of choice for increasing milk production when it is available. Dr. Jack Newman, a pediatrician with a lactation clinic in Toronto, Canada, has prescribed domperidone for years with his patients and reports excellent results and very few side-effects.(8)  The American Academy of Pediatrics has rated domperidone as “usually compatible with breastfeeding,” and lactation pharmacist expert Tom Hale has rated it L1 (safest), the best rating possible for a drug to be used by a breastfeeding mother.(9)

The traditional and most accepted dosage of domperidone as a galactogogue is 10-20 mg three to four times a day for a total of 30-80 mg daily,(10) though Dr. Newman has recently begun recommending up to 90-160 mg daily (30 mg 3x/day to 40 mg 4x/day).(11) The ramifications of long-term higher dosages are unknown in breastfeeding mothers and babies, though diabetic patients with digestion problems  have reportedly used up to 120 mg daily for as long as 12 years with no apparent ill effects.(12), (13) The greatest expressed concern with using the higher dosages is that for certain women (those with known or unknown health issues, or on other particular medications), the higher amounts may possibly cause problems that are not seen with the traditional dosages; there simply is not yet enough experience with higher dosages in breastfeeding women. US mothers who are interested in domperidone are strongly encouraged to dialogue with their physicians.

 

Tablet Therapeutic Dose

40-80 mg per day (see dosage discussion above)

Potential Side Effects

  • Dry mouth (rare)
  • Skin rash, itching (rare)
  • Headache which disappeared when dose was reduced (rare)
  • Abdominal cramps (rare)
  • Drowsiness (rare)
  • Has caused breast tumors in rodents when given in vast quantities over exceedingly long periods of time – this effect has never been documented in humans

 

See "Is Domperidone Safe and Can it be Obtained Legally in the US?"

 

How to Obtain Domperidone

 

Other Articles about Domperidone

Domperidone: Discovering New Choices for Lactating Mothers
by Amanda Henderson, RN, BSN, BS, IBCLC (AWHONN Lifeline 2003; 7:54-60)

Domperidone by Dr. Jack Newman

Canadian research study of Domperidone and milk production rates

Inhouse Drugstore article about Domperidone and milk production

Inhouse Drugstore general article about Domperidone

Breastfeedingonline.com articles about Domperidone and Reglan (some repetition of material also found on this site)

American Academy of Pediatrics. (2001). The transfer of drugs and other chemicals into human milk. Pediatr, 108(3), 776-789.

Association of Women's Health, Obstetric and Neonatal Nurses. (1999). Breastfeeding: Clinical position statement.

Association of Women's Health, Obstetric and Neonatal Nurses. (2001). Women's health research: Policy position statement.

Henderson, A. Domperidone: Discovering New Choices for Lactating Women. AWHONN Lifelines. 7(1):54-60.

Lawrence, R. (2000). Herbs and breastfeeding. Breastfeeding.com.

MEDLINEplus.Domperidone (Systemic). Drug information.

National Digestive Diseases Information Clearinghouse. (1999). Gastroparesis and diabetes. NIH Publication No. 99-4348.

Newman, J. (2005). Domperidone, #19.

Silva, O., Knoppert, D. C., Angelini, M. M., & Forret, P. A. (2001). Effect of domperidone on milk production in mothers of premature newborns: A randomized, double-blind, placebo-controlled trial. Can Med Assoc J, 164(1), 17-21.

 

References

(1) Newman, J. and T. Pitman. The Ultimate Breastfeeding Book of Answers. Roseville, CA: Prima Publishing, 2000; 85, 86-89.

(2) Da Silva, O., Knoppert, D., Angelini, M., et al. Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial. CMAJ 2001; 164(1):17-21.

(3) Riordan, J. Breastfeeding and Human Lactation, 3rd edition.  Sudbury, MA: Jones and Bartlett Publishers, 2004. 

(4) Hofmeyr, G., and B. van Iddeking. Domperidone and lactation. Lancet 1983; I: 647.

(5) Petraglia, F., De Leo, V., Sardelli, S., et al. Domperidone in defective and insufficient lactation. Eur J Obstet Gynecol Reprod Biol  May 1985; 19(5):281-87.

(6) Brown, T., Fernandes, P., Grant, L., et al. Effect of parity on pituitary prolactin response to metoclopramide and domperidone: implications for the enhancement of lactation. J Soc Gynecol Investig Jan-Feb 2000; 7(1):65-69.

(7) De Leo, V., Petraglia, F., Sardelli, S., et al.  Use of domperidone in the induction and maintenance of maternal breast feeding. Minerva Ginecol  Apr 1986; 38(4): 311-15.

(8) Gabay, M. Galactogogues: medications that induce lactation. J Hum Lact 2002 Aug; 18(3):274-9.

(9) Newman, J. and T. Pitman. The Ultimate Breastfeeding Book of Answers. Roseville, CA: Prima Publishing, 2000; 85-89.

(10) Hale, T.  Medications and Mothers’ Milk, 11th edition.  Amarillo, TX: Pharmasoft Publishing, 2004; 259-60.

(11) Hale, T.  Medications and Mothers’ Milk, 11th edition.  Amarillo, TX: Pharmasoft Publishing, 2004; 259.

(12) ,Newman, J.  Handout #19a, January 2005. 

(13) Prakash, A. and A. Wagstaff. Domperidone. A review of its use in diabetic gastropathy. Drugs. 1998 Sep;56(3):429-45.

 

 
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