Domperidone for Increasing Milk Supply
Domperidone is effective as a galactagogue and can be used to increase milk supply in lactating women, with low levels transferring to breast milk due to first-pass hepatic and intestinal metabolism. 1, 2
Mechanism and Efficacy
Domperidone functions as a galactagogue by:
- Acting as a dopamine receptor antagonist
- Increasing prolactin levels, which enhances milk production 2
- Demonstrating significant increases in milk volume in clinical studies 3
A 2021 randomized controlled trial showed that domperidone treatment increased breast milk production from a baseline of 156 mL to 400.9 mL after 14 days of treatment, compared to more modest increases in the placebo group (175.8 mL to 260.5 mL) 3. Additionally, 95% of babies whose mothers received domperidone were exclusively breastfeeding at hospital discharge, compared with only 52.4% in the placebo group.
Safety Profile
Domperidone has several important safety considerations:
- Very low transfer to breast milk (0.01-0.35% relative infant dose) 2
- High plasma protein binding (93%) with a half-life of 7-14 hours 2
- Lower incidence of side effects compared to metoclopramide 2
Important Safety Warning
Despite its efficacy, domperidone has been associated with cardiac risks including QT prolongation, torsades de pointes, and sudden cardiac death 4. The U.S. Food and Drug Administration (FDA) has issued safety warnings regarding its use for lactation enhancement and has not approved it for any human use in the United States 4.
Recommended Dosage
The recommended dosage for domperidone as a galactagogue is:
- 10 mg three times daily for 10-14 days 2
- Some evidence suggests that 20 mg three times daily may provide clinically better results, though the difference was not statistically significant in studies 5
- Gradual tapering rather than abrupt discontinuation is recommended to prevent sudden drops in milk supply 2
Clinical Approach
Before initiating domperidone:
- Evaluate and address other factors affecting lactation (proper latch, feeding frequency, hydration)
- Consider an electrocardiogram to rule out cardiac abnormalities 6
- Monitor for potential side effects (headache, abdominal pain) 6
Alternative Options
If domperidone is unavailable or contraindicated:
- Metoclopramide can be used (10 mg three times daily for 10-14 days) 2
- However, metoclopramide has a higher relative infant dose (4.7-14.3%) and more maternal side effects including fatigue, nausea, headache, and dry mouth 2
Practical Considerations
When using domperidone as a galactagogue:
- Ensure the woman has access to a breast pump if there is any delay in feeding her infant 1
- Monitor milk production and any potential side effects 2
- Be aware of regional regulatory status (not approved in the US but used in Canada, Australia, and the UK) 6
Meta-analyses have shown domperidone produces a statistically significant relative increase of 74.72% in daily milk production compared to placebo 7, making it an effective option for mothers experiencing insufficient lactation.