An In-Depth Discussion on Domperidone

Because lactation is so important to many women who hope to produce breast milk for their nursing partner, they will sometimes turn to a galactagogue to aid in the milk-making process. A galactagogue is a substance that is used to increase breast milk supply, and while many of the most commonly used galactagogues are taken in the forms of herbal supplements, there are also several prescription medications that can help to increase milk production and supply in nursing women. Domperidone is one of them.
I have been asked about this medication on several occasions, and I honestly knew very little about it. As a matter of fact, the first time that I heard the word “domperidone” was right after my oldest son was born, during my first appointment with my lactation consultant. I was very fortunate to have an abundant milk supply that did not require the use of supplements or prescription medications to thrive. The truth about producing non-maternal breast milk remains: it is a sometimes extremely challenging process that takes a great deal of concentrated effort and hard work, and is often achieved simply by properly employing a variety of tried-and-true old-fashioned lactation techniques. But some women still feel the need for an additional supplement, and because a few continued to express a true interest in domperidone, I decided to do quite a bit of research on the medication. After reading various studies written by reputable physicians and reports released by notable breastfeeding clinics, I then discussed the medication with both a registered Labor and Delivery nurse (my dear friend Holly) and a certified lactation consultant, and compiled everything that I learned about domperidone into this article. As with any medication, opinions on its effectiveness, safety, and risk factors vary greatly, and there is even a debate about how readily available and easily obtainable it is, so I decided the best thing to do would be to provide the most unbiased and timely information that I possibly could as a way to help others who may be considering domperidone as a lactation option. Popular consensus does agree on three important factors: 1. NO medication is 100% safe, 2. Domperidone is not a “magical cure-all”, and 3. This drug does not work in all women and would not be expected to increase milk production in a woman who already has normal prolactin levels.
There is other information on domperidone, of course, so you’ll probably want to do your own research on the subject to determine if this medication is right for you; I hope this simply helps you along the way. 🙂
 Domperidone  is a drug that has the increase of milk production as one of its side effects, which is thought to be caused by increasing prolactin production by the pituitary gland. Prolactin is the hormone that stimulates the cells in the breast to produce milk. Domperidone increases prolactin secretion in an indirect way, by interfering with the action of dopamine, which decrease the release of prolactin by the pituitary gland. Domperidone is generally used for disorders of the gastrointestinal tract (stomach). Many pharmaceutical companies do not back the medication’s use for increasing milk production; however, there are several studies that show that it works to increase milk production, and may have fewer unacceptable side effects than older medications that were once used as a galactagogue because domperidone does not pass the blood-brain barrier, which prevents it from entering the brain tissue in significant amounts.
Domperidone should never be used as the first method of increasing personal milk production; it is best to first use other inducing methods to build and manage breast milk supply. Women who take domperidone will need to continue with their traditional inducing routine to achieve their best results.
You can work on building your breast milk supply by:
  1. Nursing skin to skin
  2. Ensuring your partner is properly latched; a good latch often makes a very big difference in the amount of breast milk a woman produces.
  3. Using breast compressions.
  4. Hand expressing for an additional 10-15 minutes after a nursing session.
  5. Correcting any suckling issues.
  6. Nursing regularly.

Side Effects of Domperidone:

As with all medications, side effects are possible, and many (some unsubstantiated) have been reported with domperidone, but symptoms are not always caused by the medication a person is taking. Some side effects do not need medical attention; they may actually go away during treatment as your body adjusts to the medicine. A qualified health care professional may be able to tell you about ways to prevent or reduce some of the side effects associated with domperidone, or may even check your progress fairly regularly to determine if medication adjustments are necessary.

Side effects may include:

  • abdominal cramps
  • dry mouth
  • change in menstrual periods (either stopping or breakthrough bleeding)
  • headache
  • hives
  • hot flashes
  • itching of skin
  • itching, redness, pain, or swelling of eye
  • pain in the breast

Rare side effects may include:

  • change in appetite
  • constipation
  • diarrhea
  • burning, difficult, or painful urination
  • difficulty in speaking
  • dizziness
  • drowsiness
  • heartburn
  • irritability
  • lack or loss of strength
  • leg cramps
  • mental dullness
  • anxiety
  • palpitations
  • sluggishness
  • stomach cramps
  • thirst
  • fatigue
  • weakness

Of the occasional cases in which women reported experiencing headaches, the symptom  faded after their personal medication dosage was lowered. Women who reported symptoms of anxiety, irritability, fatigue, and weakness had either 1. been taking domperidone for an extended period of time (over 1 year) or 2. had abruptly stopped taking their medication without “weaning” themselves off of it.  The most commonly reported side effect is an increase in milk production, supply, and flow.

Using Domperidone Properly:

It is extremely important that you take this medication as directed by a qualified healthcare professional. Generally, it is administered orally, in 10 mg tablets, and often started at 30 mg (three 10 mg tablets) 3 times a day, every eight hours, at the woman’s convenience. It isn’t necessary to set an alarm clock for middle of the night dosages, as this makes no difference to the medication’s effectiveness. Of course, your personal treatment plan will be determined by your own physician. Because domperidone is used for a variety of digestive problems, it is often suggested that patients take the medication 30 minutes before eating; however, absorption of domperidone is greater on an empty stomach. Typically, women hoping to boost breast milk supply take domperidone for 3 to 8 weeks, but those who are hoping to achieve non-maternal lactation may need to take the medication for much longer periods of time to see results.

After starting domperidone, it may take three or four days before you notice any effect, and, typically, it takes approximately two to three weeks to get a maximum effect; it is recommended that women continue to take  domperidone for at  least four to six weeks before determining its effectiveness.

It is possible to overdose on domperidone, so if you experience any of the following symptoms, it is extremely important that you seek medical attention immediately:

  • difficulty speaking
  • disorientation
  • dizziness
  • fainting
  • irregular heartbeat
  • light-headedness
  • loss of balance or muscle control (less common)
  • swelling of the mouth (less common)
  • fast, irregular, pounding, or racing heartbeat or pulse (rare)
  • swelling of face, hands, lower legs, or feet (rare)

If you miss a dose of domperidone, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Medication Interactions:

Some medications should not be used together, as an adverse drug interaction might occur. The list of prescription medications that may negatively interact with domperidone is quite extensive, and not necessarily all-inclusive. Some of the medications listed, such as Cisapride, may no longer be on the market, but I am including them for your personal reference:

  • Amifampridine
  • Bepridil
  • Cisapride
  • Darunavir
  • Dronedarone
  • Fluconazole
  • Ketoconazole
  • Mesoridazine
  • Pimozide
  • Piperaquine
  • Posaconazole
  • Saquinavir
  • Sparfloxacin
  • Terfenadine
  • Thioridazine
  • Ziprasidone

and:

  • Abiraterone
  • Alfuzosin
  • Alprazolam
  • Amiodarone
  • Amitriptyline
  • Amlodipine
  • Amoxapine
  • Amprenavir
  • Anagrelide
  • Apomorphine
  • Aprepitant
  • Aripiprazole
  • Arsenic Trioxide
  • Artemether
  • Asenapine
  • Astemizole
  • Atazanavir
  • Atorvastatin
  • Azithromycin
  • Bedaquiline
  • Bicalutamide
  • Boceprevir
  • Buserelin
  • Ceritinib
  • Chloroquine
  • Chlorpromazine
  • Cimetidine
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clozapine
  • Cobicistat
  • Conivaptan
  • Crizotinib
  • Cyclobenzaprine
  • Cyclosporine
  • Dabrafenib
  • Dasatinib
  • Degarelix
  • Delamanid
  • Delavirdine
  • Desipramine
  • Deslorelin
  • Diltiazem
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Donepezil
  • Doxepin
  • Droperidol
  • Ebastine
  • Eribulin
  • Erythromycin
  • Escitalopram
  • Famotidine
  • Felbamate
  • Fingolimod
  • Flecainide
  • Fluoxetine
  • Fluvoxamine
  • Formoterol
  • Fosamprenavir
  • Fosaprepitant
  • Foscarnet
  • Fosphenytoin
  • Galantamine
  • Gatifloxacin
  • Gemifloxacin
  • Ginkgo Biloba
  • Goldenseal
  • Gonadorelin
  • Goserelin
  • Granisetron
  • Halofantrine
  • Haloperidol
  • Histrelin
  • Hydroquinidine
  • Hydroxychloroquine
  • Ibutilide
  • Idelalisib
  • Iloperidone
  • Imatinib
  • Imipramine
  • Indinavir
  • Isoniazid
  • Itraconazole
  • Ivabradine
  • Lapatinib
  • Leuprolide
  • Levofloxacin
  • Lithium
  • Lopinavir
  • Lumefantrine
  • Mefloquine
  • Methadone
  • Metronidazole
  • Miconazole
  • Mifepristone
  • Mizolastine
  • Moxifloxacin
  • Nafarelin
  • Nefazodone
  • Nelfinavir
  • Netupitant
  • Nilotinib
  • Norfloxacin
  • Nortriptyline
  • Octreotide
  • Ofloxacin
  • Ondansetron
  • Paliperidone
  • Panobinostat
  • Paroxetine
  • Pasireotide
  • Pazopanib
  • Pentamidine
  • Perflutren Lipid Microsphere
  • Perphenazine
  • Pipamperone
  • Probucol
  • Procainamide
  • Prochlorperazine
  • Promethazine
  • Propafenone
  • Protriptyline
  • Quetiapine
  • Quinidine
  • Quinine
  • Ranitidine
  • Ranolazine
  • Rilpivirine
  • Risperidone
  • Ritonavir
  • Salmeterol
  • Selegiline
  • Sertindole
  • Sevoflurane
  • Sodium Phosphate
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate, Monobasic
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sunitinib
  • Tacrolimus
  • Tamoxifen
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Tetrabenazine
  • Ticagrelor
  • Tizanidine
  • Tolterodine
  • Toremifene
  • Trazodone
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Vilanterol
  • Vinflunine
  • Voriconazole
  • Vorinostat

Food Interactions:

Grapefruit juice may negatively interact with domperidone.

Medical Conditions to Discuss with your Doctor:

Before taking domperidone, it is important to discuss any pre-existing medical conditions, including, but not limited to, bleeding from the stomach or other issues with the bowels, pituitary (brain) tumor, and/or liver disease,  with your healthcare provider.

Long-Term Effects and Other Information:

Domperidone has been used successfully in Canada and other parts of the world, and has been given Lactation Risk Category L1 (“safest”). Following a 2004 report issued by the FDA, which stated that domperidone caused cardiac arrest and arrhythmias in patients, the medication is no longer available in the U.S.

An article published in April 2016 by the FDA states the following:

Background and Important Safety Information

Domperidone is not currently a legally marketed human drug and it is not approved for sale in the U.S. On June 7, 2004, FDA issued a public warning that distributing any domperidone-containing products is illegal. FDA also issued an Import Alert instructing FDA field personnel to detain shipments of finished drug products and bulk ingredients containing domperidone, and refuse admission into the US. FDA took this action because of the concern about the potential serious health risks associated with the use of domperidone by lactating women to enhance breast milk production.

The serious risks associated with domperidone include cardiac arrhythmias, cardiac arrest, and sudden death. These risks are related to the blood level of domperidone, and higher levels in the blood are associated with higher risks of these events. Concurrent use of certain commonly used drugs, such as erythromycin, could raise blood levels of domperidone and further increase the risk of serious adverse cardiac outcomes.

How to Get Domperidone for Gastrointestinal Disorders

FDA recognizes that there are some patients with severe gastrointestinal motility disorders that are difficult to manage with available therapy for whom domperidone’s potential benefits may justify its potential risks. Patients 12 years of age and older with certain gastrointestinal (GI) conditions who have failed standard therapies may be able to receive treatment with domperidone through an expanded access investigational new drug application (IND). These conditions include gastroesophageal reflux disease with upper GI symptoms, gastroparesis, and chronic constipation.

Physicians

Physicians interested in submitting an expanded access IND for domperidone can download the Domperidone Packet, which contains the required forms, instructions, and answers to most questions or contact DDI (above) to discuss domperidone.

Patients

Please have your physician download the Domperidone Packet or contact DDI (above) to discuss domperidone.

Pharmacies

If you are interested in distributing domperidone to IND holders under the FDA’s expanded access program, please contact DDI (above) to discuss domperidone.

Resource: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/InvestigationalNewDrugINDApplication/ucm368736.htme:

While there have been some reported cases of short-term side effects stemming from the use of domperidone, they are very few and almost always very mild. Worldwide experience with domperidone over approximately two decades suggests that long-term side effects are also rare.

The amount of domperidone that passes through breast milk is relatively small, so it should be perfectly safe for your partner to nurse if you are taking this medication.

Domperidone seems to work best when a woman is already lactating; it is typically used to increase milk supply rather than induce lactation.

How to Stop Taking Domperidone:

Below is a general guideline on how the use of domperidone is normally stopped. Your physician will be able to determine what is best for you.

  1. When the time has come to start weaning from the medication, drop one pill.
  2. Wait four to seven days, and if you see no change in your milk supply, drop another pill.
  3. Wait another four to five days, and, again, if you see no change in your milk supply, drop another pill.
  4. 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, you should be able to manage, boost, and maintain your supply with nursing sessions and other inducing techniques (such as manual expression and pumping).

In some cases, women will need to continue increasing and decreasing the amount of domperidone they take over two week cycles until they achieve a level of dosage effectiveness. Basically, domperidone is simply intended as an aid to help with successful lactation so that a woman can maintain a beautiful and adequate supply of breast milk that she is comfortable with.

I hope you found this information helpful. 🙂

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