From the Guidelines
Domperidone (Motilium) is safe to use during breastfeeding, as levels in milk are low due to first-pass hepatic and intestinal metabolism. When taken orally, domperidone is used as a galactagogue to increase milk supply, and it is essential to ensure the woman has access to a breast pump if there is any delay in feeding her infant 1. The use of domperidone during breastfeeding is supported by its low oral bioavailability and minimal transfer into breast milk.
Key Points to Consider
- Domperidone may increase milk supply, making it a beneficial option for lactating women struggling with milk production 1.
- The medication should be used with caution in women with cardiac conditions, as it can cause QT prolongation in rare cases.
- Before starting domperidone, it is crucial to consult with a healthcare provider who can evaluate the specific situation and monitor for any adverse effects.
- Non-pharmacological methods, such as frequent nursing, proper latch, and adequate hydration, should be tried before initiating domperidone therapy.
- The medication can be discontinued gradually, and breastfeeding can continue normally while taking it.
Important Considerations
- Domperidone is not approved for lactation purposes in some countries, including the US.
- Side effects may include headache, dry mouth, and abdominal cramps.
- It is essential to weigh the benefits and risks of using domperidone during breastfeeding and to closely monitor the infant for any adverse effects 1.
From the Research
Safety of Domperidone during Breastfeeding
- The safety of domperidone (Motilium) during breastfeeding has been evaluated in several studies 2, 3, 4, 5, 6.
- A 2016 study developed a domperidone treatment protocol for mothers of hospitalized premature infants with insufficient milk supply, aiming to facilitate safer prescribing practices and minimize potential adverse reactions 2.
- A 2021 randomized, double-blinded, placebo-controlled trial found that domperidone treatment resulted in an increase in breast milk production with no adverse effects 3.
- A 2021 systematic review and meta-analysis concluded that domperidone can be used to treat low milk supply in women with preterm infants without significant side effects 4.
- A 2019 pilot study found that domperidone was effective in increasing milk production in Japanese mothers with insufficient lactation, with no adverse cardiac events 5.
- However, a 2017 commentary raised concerns about the regulatory status and available evidence regarding domperidone for insufficient lactation, citing associations with serious cardiac arrhythmias and limited quality evidence for its effectiveness 6.
Efficacy of Domperidone in Increasing Milk Production
- Studies have shown that domperidone can increase breast milk production in mothers with low milk supply 3, 4, 5.
- A 2021 study found that domperidone treatment resulted in a significant increase in daily human milk volume in mothers of preterm infants with low milk supply 4.
- A 2019 pilot study found that 7 out of 10 Japanese mothers with insufficient lactation increased their milk production after taking domperidone 5.
Adverse Effects of Domperidone
- Studies have reported minimal adverse effects associated with domperidone use in breastfeeding mothers 3, 4, 5.
- A 2021 study found no adverse effects in mothers taking domperidone 3.
- A 2019 pilot study reported mild adverse events, including headache and abdominal pain, in two mothers taking domperidone 5.
- However, a 2017 commentary highlighted the potential for serious cardiac arrhythmias, including QT prolongation, torsades de pointes, and sudden cardiac death, associated with domperidone use 6.