What is the recommended dose of domperidone (antiemetic and prokinetic agent) for lactation?

Recommended Dosage of Domperidone for Lactation Enhancement

The recommended dosage of domperidone for lactation enhancement is 10 mg three times daily for 2-4 weeks, with possible gradual tapering afterward. 1

Dosing Information

• Domperidone is commonly used as a galactagogue to increase milk supply in lactating women 1
• Standard dosing regimen: 10 mg three times daily for 2-4 weeks 2, 3
• Higher dosage (20 mg three times daily) has shown clinically, but not statistically significant, greater increase in milk production compared to 10 mg three times daily 4
• After the initial treatment period, the dose can be gradually tapered: reduced to twice daily for 1 week, then once daily for 1 week before discontinuation 4

Efficacy and Safety Profile

• Domperidone works by increasing prolactin levels, which stimulates milk production 2, 5
• In clinical studies, domperidone significantly increased breast milk production from baseline (156 mL to 400.9 mL after 14 days of treatment) 2
• Domperidone has a favorable safety profile for lactation with very low transfer to breast milk:
  • Milk:plasma ratio of 0.25 (well below the concerning threshold of 1.0) 1
  • Relative infant dose of only 0.01-0.35% (well below the 10% threshold of concern) 1
  • First-pass hepatic and intestinal metabolism results in low levels in milk 1

Important Considerations and Monitoring

• Ensure the mother has access to a breast pump if there is any delay in feeding her infant, as domperidone may increase milk supply significantly 1
• No significant adverse effects have been reported in breastfeeding infants whose mothers take domperidone at recommended doses 2
• In some countries (notably the United States), domperidone is not approved for any human use, including lactation enhancement, due to concerns about cardiac arrhythmias 6
• Cardiac monitoring may be warranted in women with risk factors for arrhythmias or QT prolongation 6

Treatment Duration

• Most studies have evaluated treatment courses of 2-4 weeks 2, 4, 3
• Significant increases in milk production are typically observed within the first 7-14 days of treatment 2, 3
• For women who respond well, gradual tapering rather than abrupt discontinuation is recommended 4

Comparative Effectiveness

• Domperidone appears to have lower transfer to breast milk compared to metoclopramide (another commonly used galactagogue) 5
• Domperidone has fewer central nervous system side effects than metoclopramide as it does not readily cross the blood-brain barrier 5
• In one study, 95% of babies whose mothers received domperidone were exclusively breastfeeding at hospital discharge, compared with 52.4% in the placebo group 2

Human Milk Production

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Recommended Dosage of Domperidone for Lactation Enhancement

The recommended dosage of domperidone for lactation enhancement is 10 mg three times daily for 2-4 weeks. 1, 2

Dosing Information

• Standard dosing regimen: 10 mg orally three times daily for 2-4 weeks 2, 3
• After the initial treatment period, the dose can be gradually tapered: reduced to twice daily for 1 week, then once daily for 1 week before discontinuation 4
• Higher dosage (20 mg three times daily) has been studied and shows a clinically greater, though not statistically significant, increase in milk production compared to the standard dose 4

Pharmacokinetic Profile

• Domperidone has high plasma protein binding (93%) 1
• It has a milk:plasma ratio of 0.25 (well below the concerning threshold of 1.0) 1
• The half-life is 7-14 hours 1
• Relative infant dose is very low at 0.01-0.35% (well below the 10% safety threshold) 1
• When taken orally, levels in milk are low due to first-pass hepatic and intestinal metabolism 1

Efficacy

• Domperidone significantly increases prolactin levels from baseline (median 72.85 ng/mL to 223.4 ng/mL after 7 days of treatment) 2
• Breast milk production typically increases from baseline volumes of approximately 156-175 mL to 400 mL after 14 days of treatment 2
• Mothers of preterm infants treated with domperidone (10 mg three times daily) are more likely to achieve a 50% increase in milk volume after 14 days compared to placebo (77.8% vs 57.8%) 3

Safety Considerations

• Domperidone is used as a galactagogue in many countries, though it is not approved for this indication in the United States 6
• No significant adverse effects have been reported in breastfeeding infants whose mothers take domperidone at recommended doses 2
• The very low transfer into breast milk makes it suitable for use during lactation 1

Clinical Application

• Ensure the mother has access to a breast pump if there is any delay in feeding her infant, as domperidone may increase milk supply significantly 1
• Domperidone should be used in conjunction with other lactation support measures, as many women (71.7% in one study) can increase milk production with proper counseling and breastfeeding management alone 2