Domperidone for Low Breast Milk Production
Domperidone is the preferred galactagogue for increasing breast milk supply in lactating women with insufficient milk production, prescribed at 10 mg orally three times daily for 14-28 days, but only after maximizing non-pharmacologic interventions and ruling out underlying medical causes. 1
Pre-Treatment Requirements
Before prescribing domperidone, you must optimize these non-pharmacologic interventions:
- Frequent feeding or pumping (at least 8-12 times per 24 hours) 1
- Proper latch technique verification with lactation consultation 1
- Adequate maternal hydration and nutrition 1
- Skin-to-skin contact to stimulate milk production 1
Rule out these underlying medical conditions that cause low supply:
- Retained placental fragments (check for prolonged bleeding, subinvolution) 1
- Thyroid dysfunction (obtain TSH if clinically indicated) 1
- Insufficient glandular tissue (assess breast development history) 1
Dosing and Administration
The standard dose is 10 mg orally three times daily for 14-28 days. 1 This regimen has demonstrated significant efficacy in clinical trials, increasing daily milk volume by approximately 90.53 mL/day in mothers of preterm infants with low milk supply. 2
Ensure the mother has access to a breast pump if any delay in infant feeding occurs, as domperidone may increase supply before the infant can effectively remove milk. 1, 3
Evidence for Efficacy
The American College of Obstetricians and Gynecologists identifies domperidone as a primary galactagogue medication, though it is not FDA-approved for this indication in the United States. 1 A 2021 systematic review and meta-analysis demonstrated that domperidone significantly increased daily human milk volume in mothers of preterm infants (mean difference = 90.53 mL/day, 95% CI [65.42 to 115.64]). 2
In a 2021 randomized controlled trial, breast milk production increased from baseline 156 mL to 400.9 mL after 14 days in the domperidone group versus 175.8 mL to 260.5 mL in the placebo group (p < 0.01). 4 Additionally, 95% of babies in the domperidone group were exclusively breastfeeding at hospital discharge compared with 52.4% in the placebo group. 4
Safety Profile
Domperidone levels in breast milk are low due to extensive first-pass hepatic and intestinal metabolism when taken orally, making it compatible with breastfeeding. 1 Meta-analysis showed no significant differences in maternal side effects with domperidone use (RR = 1.20,95% CI [0.74 to 1.97]). 2
However, domperidone carries serious cardiac risks including QT prolongation, torsades de pointes, and sudden cardiac death. 5 The FDA issued a public safety warning regarding domperidone use for lactation and an import alert making its importation illegal with limited exceptions. 5
Critical Caveats
- Domperidone is not FDA-approved for any indication in the United States, though it is approved in other countries for gastrointestinal disorders. 1, 5
- Screen for cardiac risk factors before prescribing, including personal or family history of arrhythmias, QT prolongation, electrolyte abnormalities, or concurrent use of QT-prolonging medications. 5
- Metoclopramide is the FDA-approved alternative galactagogue in the United States, though domperidone is more commonly utilized internationally and has demonstrated superior efficacy in mothers of preterm infants. 1, 3, 2
- Most mothers (71.7% in one study) can increase milk production without pharmacological treatment after proper counseling on breastfeeding management. 4