Does Domperidone Cause Lactation?
Yes, domperidone induces lactation by stimulating prolactin release, making it an effective galactagogue for increasing breast milk supply in women with insufficient milk production. 1, 2
Mechanism of Action
Domperidone works as a dopamine-2 receptor antagonist that blocks the inhibitory effect of dopamine on prolactin secretion. 3 This mechanism leads to:
- Elevated prolactin levels: Prolactin increased from baseline 72.85 ng/mL to 223.4 ng/mL after 7 days of treatment (p=0.005), compared to minimal changes with placebo. 4
- Increased milk production: Breast milk volume increased from 156 mL at baseline to 400.9 mL after 14 days of domperidone treatment, significantly more than placebo (260.5 mL). 4
- Higher exclusive breastfeeding rates: 95% of infants in the domperidone group were exclusively breastfeeding at hospital discharge versus only 52.4% in the placebo group (p=0.008). 4
Clinical Use as a Galactagogue
The American College of Obstetricians and Gynecologists identifies domperidone as a primary galactagogue medication for inducing lactation, though it is not FDA-approved for this indication in the United States. 1, 2
Recommended Dosing Protocol
- Standard dose: 10 mg orally three times daily for 14-28 days 1
- Treatment duration: Typically 2-4 weeks based on response 1
Pre-Treatment Requirements
Before prescribing domperidone, the following steps must be completed:
- Optimize non-pharmacologic interventions first: Frequent feeding or pumping (8-12 times per 24 hours), proper latch technique verification, adequate maternal hydration and nutrition, and skin-to-skin contact 1
- Rule out underlying medical causes: Retained placental fragments, thyroid dysfunction, and insufficient glandular tissue must be excluded 1
- Ensure breast pump access: Supply may increase before the infant can effectively remove milk 2
Safety Profile in Lactation
Domperidone levels in breast milk are low due to extensive first-pass hepatic and intestinal metabolism, making it compatible with breastfeeding. 1
- Mean domperidone concentration in breast milk during treatment (10 mg three times daily) was only 2.6 ng/mL 5
- This is considerably less than levels seen with alternative galactagogues like metoclopramide and sulpiride relative to therapeutic dosage 5
- No adverse effects in infants were recorded in clinical trials 4
Important Caveats and Contraindications
Cardiac Safety Concerns
While domperidone is effective for lactation, the FDA issued warnings regarding cardiac risks including QT prolongation, torsades de pointes, and sudden cardiac death. 6 These risks must be weighed against benefits:
- Domperidone is not FDA-approved for any indication in the United States 6
- The FDA issued an import alert making importation illegal except under investigational new drug applications 6
- Cardiac screening may be warranted in women with pre-existing cardiac conditions or risk factors for arrhythmias 6
Regulatory Status
- Not approved in any country specifically for lactation enhancement 6
- Approved in some countries (Canada, Europe) for gastrointestinal disorders 3
- Used off-label for lactation based on its prolactin-elevating side effect 3
Comparison to Alternatives
Metoclopramide is FDA-approved and also functions as a galactagogue, but domperidone is more commonly utilized despite lack of FDA approval. 2 The key distinction is that domperidone does not cross the blood-brain barrier as readily, potentially reducing central nervous system side effects. 3, 5
Both metoclopramide and domperidone should be avoided when the goal is to decrease milk supply, as they are galactagogues that increase rather than decrease lactation. 7