Domperidone

Herzl Family Practice Centre, Goldfarb Breastfeeding Clinic Patient handout

What is domperidone?

• Domperidone is a pill that can increase breastmilk by increasing your levels of prolactin (the hormone responsible for milk production).
• This pill was originally developed for stomach problems such as reflux and nausea. However, it is now being used widely in breastfeeding mothers.

Who needs it?

1. Domperidone is not for everyone. There are specific reasons for this medication.
2. If you feel you do not have enough milk, you should first see a lactation consultant and/or doctor.
3. It is important to try other ways of increasing milk supply first (without pills).
4. Other medical problems may need to be treated first. Blood tests may need to be done.

Is domperidone safe?

• Domperidone is the only breastmilk-increasing medication studied and shown to be safe and effective.
• It has been used safely for many years in many developed countries including Canada, Australia and European countries.

Domperidone is also approved by Health Canada for use in children and adults for stomach problems. In fact, the dose received by the infant through breastmilk is far less than the dose given to children.

What to be careful about when taking domperidone:

Domperidone, like all medicine, may have side effects and risks. However, we believe that breastfeeding while on domperidone is a safer alternative than having to give formula.

If you have had any of the following conditions, you should discuss this with a doctor before starting domperidone:

• History of bowel or colon surgery.
• Gastrointestinal conditions causing problems with digestion or absorption.
• Heart conditions causing chest pain, shortness of breath, palpitations, fainting or dizzy spells or if you have been diagnosed with having long QT waves.
• A family history of heart problems, unexplained fainting or sudden death.
• History of heart surgery.
• A brain tumor (prolactinoma) causing increased prolactin.

Domperidone can interact with other medication. It is important that you tell your doctor or pharmacy you are taking domperidone before you are given any medication.

Medications that may interact with domperidone:

• Cisapride (Propulsid™)
• Medications used to treat fungal infections or thrush, i.e. fluconazole (Diflucan™)
• Some antibiotics, i.e. ciprofloxacin (Cipro™), levofloxacin (Levaquin™), erythromycin, and azythromycine (Zithromax™).
• Grapefruit and its juice (and possibly grapefruit seed extract).
• Some antidepressants, i.e. amitriptyline (Elavil™), fluoxetine (Prozac™), and paroxetine (Paxil™).
• Lithium.
• Some HIV medication.

How to take domperidone:

• Usually, you will be asked to start domperidone at a dose of 10 mg (or 1 pill) 4 times a day. The maximum dose is 30 mg (3 pills) 4 times a day.
• You may feel an increase in milk production anywhere from 2 -3 days to 2-3 weeks after starting domperidone.
• Domperidone is a long-term medication. You have to take it continuously for at least 3 to 8 weeks for it to have its full effect. Most mothers take it for a few months, and stop gradually after discussion with their health professional.
• It is important to continue pumping and putting the baby to the breast as often as possible while on domperidone. Domperidone does not act alone. It is helped by breast stimulation. If the breasts are not stimulated, domperidone will not be able to do its job as well.
• You may continue taking herbs along with domperidone, if you feel that the herbs are helping as well.

Side effects:

Side effects are not very common, and usually improve after a week of taking domperidone.

The main side effects are:

• Headache
• Dry mouth
• Dizziness
• Diarrhea (or change in bowel movements), abdominal cramps
• Increased appetite
• Weight gain
• Fatigue