From the Guidelines
Domperidone is a viable option to increase breast milk supply, with low levels in milk due to first-pass hepatic and intestinal metabolism, as evidenced by the 2020 guideline from the Association of Anaesthetists 1. When considering the use of domperidone for this purpose, it's essential to weigh the potential benefits against the possible side effects. The medication works by blocking dopamine receptors, which in turn increases prolactin levels and enhances milk production. Key points to consider include:
- Low levels of domperidone in breast milk due to extensive first-pass metabolism 1
- Potential to increase milk supply, making it a useful galactagogue 1
- Importance of ensuring the woman has access to a breast pump if there is any delay in feeding her infant 1
- Common side effects, although not explicitly listed in the provided evidence, are generally known to include headache, dry mouth, abdominal cramps, and sometimes diarrhea
- Rare but serious side effects, such as heart rhythm abnormalities, particularly in those with pre-existing heart conditions or electrolyte imbalances, necessitate medical supervision Before initiating domperidone, mothers should optimize breastfeeding techniques, frequency of feeding or pumping, and ensure adequate hydration and nutrition. Medical supervision is crucial when using this medication to monitor for side effects and potential drug interactions, especially in individuals with liver or heart problems. The dosage and treatment duration may vary, but typically, domperidone is started at a lower dose and adjusted as needed, with treatment usually continuing for a few weeks before being gradually tapered off as the milk supply stabilizes.
From the Research
Effects of Domperidone on Breast Milk Supply
- Domperidone has been shown to increase breast milk production in mothers with lactation failure, with a significant increase in daily human milk volume [(2,3,4)].
- A study found that breast milk production increased from a baseline of 156 mL to 400.9 mL in the domperidone group, compared to an increase from 175.8 mL to 260.5 mL in the placebo group 2.
- Domperidone has been found to stimulate the release of prolactin, thereby increasing breast milk production [(2,5,3)].
Potential Side Effects of Domperidone
- No adverse effects were recorded in a study of 47 mothers who took domperidone for 14 days 2.
- However, domperidone has been associated with serious cardiac arrhythmias, including QT prolongation, torsades de pointes, and sudden cardiac death 6.
- A study of 10 Japanese mothers found that two mothers experienced mild adverse events, including headache and abdominal pain, but there were no adverse cardiac events 3.
- A systematic review and meta-analysis found that domperidone did not show significant differences in maternal side effects in women with preterm infants 4.