Domperidone Dosing for Breastfeeding
The recommended dose of domperidone for increasing breast milk production is 10 mg orally three times daily (30 mg/day total), which can be increased to 20 mg three times daily (60 mg/day total) if the lower dose is insufficient. 1, 2
Standard Dosing Protocol
Initial Dose
- Start with 10 mg orally three times daily (30 mg/day total) for mothers experiencing lactation failure despite non-pharmacological interventions 1, 3, 4
- This lower dose should be maintained for at least 14 days to assess efficacy 3, 5
Dose Escalation
- If milk production remains inadequate, increase to 20 mg three times daily (60 mg/day total) 2
- The higher dose (20 mg TID) produces a clinically significant increase in milk production compared to 10 mg TID, though the difference may not reach statistical significance 2
Duration of Treatment
- Continue treatment for 4 weeks at the therapeutic dose 2
- After 4 weeks, taper the frequency to twice daily for 1 week, then once daily for 1 additional week before discontinuation 2
- Some protocols use 14-28 days of continuous treatment before tapering 3, 5
Clinical Context and Timing
When to Initiate
- Domperidone should only be started after optimizing non-pharmacological interventions including frequent feeding/pumping, proper latch technique, adequate maternal hydration and nutrition 6
- Approximately 72% of mothers with perceived lactation failure can increase milk production with counseling alone, so pharmacological treatment should be reserved for true lactation failure 3
- Domperidone can be initiated as early as the first week postpartum if lactation failure is documented 7
Expected Efficacy
- Mothers receiving 20 mg TID (60 mg/day) increased milk production from baseline of 156 mL to 401 mL after 14 days 3
- 77.8% of mothers achieve a 50% or greater increase in milk volume when domperidone is started within 21 days postpartum 5
- The medication works by antagonizing dopamine and elevating prolactin levels, with prolactin levels increasing significantly by day 7 of treatment 3
Safety Considerations and Side Effects
Common Adverse Effects
- Side effects occur in approximately 48% of women and appear to be dose-related 7
- Most common side effects include weight gain (25%), headaches (17%), and dry mouth (13%) 7
- Higher doses (>60 mg/day) are associated with 73% incidence of side effects compared to 38% at doses ≤30 mg/day 7
- Approximately 9% of women discontinue domperidone due to side effects 7
Compatibility with Breastfeeding
- Domperidone is compatible with breastfeeding and is listed as a safe anti-emetic option for breastfeeding women 1
- Mothers should have access to a breast pump if any delay in infant feeding occurs, as domperidone may increase milk supply before the infant can effectively remove it 6
Important Caveats
Regulatory Status
- Domperidone is not FDA-approved in the United States for use as a galactagogue, though it is widely used internationally for this indication 6
- Metoclopramide (maximum 30 mg/day) is the FDA-approved alternative in the United States, though domperidone is more commonly utilized globally 6
Dosing Variability in Practice
- Real-world surveys show wide variation in dosing, with some women using doses as high as 160 mg/day, though this exceeds evidence-based recommendations 7
- Doses above 60 mg/day are associated with significantly higher side effect rates without clear evidence of additional benefit 7