Recommended Dose of Domperidone for Low Milk Supply
The recommended dose of domperidone for lactating women with low milk supply is 10 mg orally three times daily (30 mg/day total) for 14-28 days, as recommended by the American College of Obstetricians and Gynecologists. 1
Pre-Treatment Requirements
Before initiating domperidone therapy, you must complete the following steps:
Optimize non-pharmacologic interventions first, including frequent feeding or pumping (at least 8-12 times per 24 hours), verification of proper latch technique, ensuring adequate maternal hydration and nutrition, and maximizing skin-to-skin contact 1
Rule out underlying medical causes of low milk supply, specifically retained placental fragments, thyroid dysfunction (TSH and free T4), and insufficient glandular tissue 1
Ensure access to a breast pump is available, as domperidone may increase milk supply before the infant can effectively remove the increased volume 1, 2
Standard Dosing Protocol
10 mg orally three times daily is the guideline-recommended dose 1
Treatment duration of 14-28 days is standard, though the optimal duration remains under investigation 1, 3
The dose should not exceed 30 mg/day in routine clinical practice, as higher doses (>60 mg/day) are associated with significantly increased side effects (73% vs 38% at standard doses) without clear evidence of superior efficacy 4
Evidence for Effectiveness
Domperidone significantly increases daily milk volume in mothers of preterm infants with low milk supply by approximately 90.53 mL/day compared to placebo 5
In a high-quality 2021 randomized controlled trial, breast milk production increased from baseline 156 mL to 400.9 mL after 14 days of domperidone treatment (p < 0.01), with 95% of infants exclusively breastfeeding at discharge compared to 52.4% in the placebo group 6
Prolactin levels increase significantly with domperidone treatment, rising from median 72.85 ng/mL to 223.4 ng/mL by day 7 (p = 0.005) 6
Safety Profile for Breastfeeding
Domperidone is compatible with breastfeeding due to minimal transfer to breast milk, with a milk:plasma ratio of 0.25 and relative infant dose of only 0.01-0.35%, well below the 10% safety threshold 7, 1
The drug has 93% plasma protein binding, which limits free drug available for milk transfer 7
Extensive first-pass hepatic and intestinal metabolism when taken orally further reduces infant exposure 1
Common Side Effects and Monitoring
Side effects occur in approximately 48% of women at standard doses (30 mg/day), including weight gain (25%), headaches (17%), and dry mouth (13%) 4
Side effects are dose-dependent, with 73% experiencing adverse effects at doses >60 mg/day versus 38% at ≤30 mg/day 4
Approximately 9% of women discontinue domperidone due to side effects 4
Critical Safety Caveat
Domperidone is not FDA-approved for any indication in the United States and carries an FDA warning regarding cardiac risks including QT prolongation, torsades de pointes, and sudden cardiac death 1, 8. However, it is approved in other countries for gastrointestinal disorders and is widely used off-label for lactation enhancement 8. The American College of Obstetricians and Gynecologists identifies it as a primary galactagogue medication despite the lack of FDA approval 1.
Clinical Context
Nearly 72% of mothers with perceived lactation failure can increase milk production through counseling and proper breastfeeding management alone, without pharmacological intervention 6
Early initiation is common in clinical practice, with 19% of women starting domperidone in the first week postpartum, though this may not be necessary if non-pharmacologic measures are optimized first 4