Domperidone Dosing for Increasing Milk Supply
The recommended dosage of domperidone for increasing milk supply in lactating women is 10 mg three times daily for 10-14 days. 1
Mechanism and Safety Profile
Domperidone functions as a galactagogue by:
- Acting as a dopamine receptor antagonist
- Increasing prolactin levels, which enhances milk production
- Has minimal transfer to breast milk with a very low relative infant dose (0.01-0.35%) 2
- High plasma protein binding (93%) and a half-life of 7-14 hours 2
Dosing Protocol
Standard Dosing Regimen
- Initial dose: 10 mg three times daily 1
- Duration: 10-14 days 1, 3
- Maximum daily dose: 30 mg (10 mg three times daily) is typically sufficient 1
Alternative Dosing Options
- Some studies have explored 20 mg three times daily (60 mg total daily dose) which showed a clinically meaningful but not statistically significant increase in milk production compared to 10 mg three times daily 4
- For tapering: After 4 weeks of treatment, consider decreasing to twice daily for 1 week, then once daily for 1 week before discontinuation 4
Efficacy
- Domperidone significantly increases breast milk production from baseline levels 3
- In one study, milk production increased from 156 ± 141.1 mL to 400.9 ± 239.2 mL after 14 days of treatment 3
- Nearly half of women in a large survey reported domperidone as "very" or "extremely effective" for increasing milk supply 5
Important Considerations
Before Starting Domperidone
- Evaluate and correct factors affecting lactation before initiating medication 1
- Ensure proper breastfeeding techniques and support are in place
- Non-pharmacological approaches should be tried first 6
Monitoring
- Monitor milk production during treatment
- Watch for potential side effects, which may include:
- Weight gain (25% of users)
- Headaches (17%)
- Dry mouth (13%) 5
Timing of Initiation
- Earlier initiation (within the first 21 days postpartum) may lead to better outcomes 7
- For mothers of preterm infants, domperidone may be particularly beneficial 7
Advantages Over Other Galactagogues
- Domperidone has a lower incidence of side effects compared to metoclopramide 1
- Metoclopramide has a higher relative infant dose (4.7-14.3%) compared to domperidone (0.01-0.35%) 2, 1
- Domperidone does not readily cross the blood-brain barrier, resulting in fewer central nervous system side effects
Practical Application
- Start with the standard dose of 10 mg three times daily
- Continue for 10-14 days while monitoring milk production
- If response is inadequate after 7 days and no side effects are present, some clinicians may consider increasing to 20 mg three times daily, though evidence for higher dosing is limited 4
- Consider tapering the dose when discontinuing after prolonged use
Remember that while domperidone can be effective in increasing milk supply, it should be used as part of a comprehensive approach to supporting lactation that includes proper breastfeeding technique, adequate hydration, and appropriate nutritional support.