I have a question regarding the optimal timing for orally administered domperidone. The drug manufacturer's instructions for orally administered domperidone is 15-30 minutes before meals. While this recommendation may be optimal for patients who are taking the drug for gastrointestinal problems (ie, the "official" use of domperidone), I am wondering if this is optimal for increaseing milk supply for lactating mothers?
I have found a couple of sources which indicate that domperidone's absorption is actually maximized after a meal.
For example:
http://larionlifesciences.com/rbp-d.htm Domperidone
Absorption
In fasting subjects, domperidone is rapidly absorbed after oral administration, with peak plasma concentrations at 30 to 60 minutes. The low absolute bioavailability of oral domperidone (approximately 15%) is due to an extensive first-pass metabolism in the gut wall and liver. Although domperidone`s bioavailability is enhanced in normal subjects when taken after a meal, patients with gastro-intestinal complaints should take domperidone 15-30 minutes before a meal. Reduced gastric acidity impairs the absorption of domperidone. Oral bioavailability is decreased by prior concomitant administration of cimetidine and sodium bicarbonate. The time of peak absorption is slightly delayed and the AUC somewhat increased when the oral drug is taken after a meal.
Note: "AUC" is a medical term defined as the area under the plasma drug concentration versus time curve; ie, a measure of drug exposure.
Also:
http://www.mieyaku.or.jp/info/data/hoken/18kyoudo/nauze/nauze.pdfThis study (at least how I interpret it) found that taking domperidone 90 minutes AFTER a meal increased absorption. "This is what was observed when domperidone was given after a meal (phase VII): althought peak time was somewhat delayed in some subjects, plasma concentrations from 2 hours after dosing were markedly higher in non-fasted than in fasted subjects (phase VI) resulting in an increase of the relative bioavailability by almost 85%."
If maximum plasma absorption leads to maximum prolactic levels and hence greater milk supply (and I certainly do NOT know if these assumptions are indeed correct), then it seems reasonable that lactating moms may be better off taking the drugs after meals.
Does anybody have any knowledge of this? (Unfortunately, it would seem difficult to know one way or the other which method maximizes milk supply without a controlled, double blind experiement.)
