What is the Big Deal with Domperidone?

WHAT IS THE BIG DEAL WITH DOMPERIDONE?

When a family decides to google ways to increase milk production, there will be hundreds of solutions. It is difficult for many mothers to decipher what is true and helpful and what may be fluff. Some answers may include the medication Domperidone. Domperidone (Motilium) is a drug that has a side effect of increasing milk production. It is currently banned in the United States, but available and prescribed in many other countries, such as Canada. Knowing the history, mechanism, and current evidence-based research on Domperidone can help families make informed decisions about utilizing this drug.

How Does it Work

Domperidone (Motilium™) is a medication that has, as a side effect, been known for increasing milk production, probably by increasing prolactin production by the pituitary gland. Domperidone increases prolactin secretion indirectly, by interfering with the activity of dopamine, whose action is to decrease the secretion of prolactin by the pituitary gland. This medication is generally used by doctors for disorders of the gut. It is not prescribed increasing milk production because the manufacturer does not back its use of increasing milk production. Dopamine is a neurotransmitter that has the responsibility of influencing mood and feelings and plays a role in the brain’s reward system, helping to reinforce certain behaviors that result in reward.

Dopamine restrains prolactin production. The more dopamine there is the less prolactin is released. Prolactin is the hormone that produces milk. Simply put, taking Domperidone assists by affecting the action of dopamine thus increasing prolactin levels and ultimately increasing the production of milk.

Banning in the US

The warning about Domperidone was issued in the United States on June 7, 2004. In this warning, breastfeeding mothers who had been using the drug to enhance production were told that it can possibly cause cardiac arrhythmias, or irregular heartbeats. But what may not be included or emphasized in answers when searching “Why Domperidone is banned in the United States?” Is that the deaths due to cardiac arrhythmias were in cancer patients who were receiving extremely high doses intravenously at the rate of every few hours. Breastfeeding mothers would not be given a dose intravenously, but for comparison, the dose prescribed would typically be a single dose in an entire 24-hour period. Intravenous doses of Domperidone  are absorbed at 100% whereas oral doses are absorbed at 13-17%

There is no such thing as a drug or medication that has never caused symptoms, and in women that are overall healthy, it is advised to work on breastfeeding issues and concerns before taking Domperidone. This may mean, working closely with a lactation professional, such as an IBCLC, to correct latch, understanding using breast compressions when feeding, or working on a schedule that best suits your personal situation. Side effects may include headaches,

It is best to use your own intuition and personal circumstance to see if a successful breastfeeding journey with the assistance of Domperidone outweighs the low possibility of side effects mentioned.

Who benefits?

The research is still not widely known on what circumstances Domperidone works best under. It has been heavily noted that moms that are pumping for a premature baby in hospital have positively seen a change in milk production when utilized around 4-5 weeks after the baby is born. Moms that have seen a decrease in production due to birth control pills also tend to have the best results when baby is 3 or 4 months old and a shift in production has occurred. In cases where a mom is trying to develop a full supply to feed an adopted baby or premature baby but has not established a full supply, Domperidone works but less dramatically. The alternatives that are FDA approved such as Metoclopramide (Maxeran and Reglan) include side effects such as fatigue, depression, involuntary body movement, and irritability

How do families use Domperidone?

Most moms will take this medication on average 4-6 weeks, but sometimes longer than that. As a reminder, with this drug being used as a gut medication, some individuals have taken it for years to treat stomach disorders. Families have stated that effect can take over as soon as 24 hours and reach maximum effect in 3-4 weeks. Dosage will be dependent on your personal situation but generally, 30 mg, 3x a day works great. Adoptive families may increase this amount slightly.

Again, currently, Domperidone is not FDA-approved in the United States. This blog is meant to provide your family with the information needed to give you a full picture to make an informed decision on if this option is for you. Lactation Consultants are a great resource for creating a plan and seeing what resources may be great for you and your journey.

TKia Robinson-Walterscheid