How long can I use
When domperidone was
being used for babies (and now that
cisapride is off the market, it is being
used again), it was common for the babies to
be on the medication for several months.
Since the amount of domperidone that gets
into the milk is very small indeed, from the
baby’s point of view, there should be no
issue in the mother taking it to increase
milk supply for several months. Our
experience with this drug is that short-term
side effects are very few and almost always
very mild. Worldwide experience with
domperidone over at least 2 decades suggests
that long-term side effects also are rare.
Some of the mothers in our clinic,
breastfeeding adopted babies, have been on
the medication for 18 months without any
apparent side effects.
How long does it
take for domperidone to work?
It depends on the
situation. In a situation where the mother
had a good milk supply, but it decreased for
some reason (e.g. going on the birth control
pill), domperidone often works very rapidly
to increase the milk supply. Often, within a
day or two, the mother is seeing a
difference (and so does her baby). But this
is not always so, and in any situation, it
may take a week or more for the mother to
get an effect. On occasion, we have had
mothers only starting to get an increase in
their milk supplies a month or more after
starting to take it. Therefore, we generally
recommended that the mother take the
domperidone for at least 6 weeks in order to
be sure whether it has worked or not.
It is our impression
that domperidone works best after the first
few weeks after the mother has given birth.
This has not been proved, but there are
theoretical reasons why it may be so. For
this reason, we have often waited to
prescribe it until the baby is at least 3
weeks, mainly because we did not want the
mother to become discouraged if she did not
see any rapid increase in her milk supply.
How do I know how
long to take domperidone?
Usually, we ask the
mother take it for two weeks and
re-evaluate. There are several
supply has increased
substantially, to the point
where there is no longer a
consideration of using
supplements, or the mother has
been able to stop supplements
with the baby continuing to gain
well on breastfeeding alone.
supply has increased to a point
that the mother feels is
satisfactory. For example, she
may still need to supplement,
but the baby does not fuss any
more at the breast and drinks
In these two
situations, we would ask the mother to start
weaning herself from the domperidone in this
1. Most mothers are
taking 2 tablets four times a day, or 3
tablets three times a day. When you are
ready to start weaning from the domperidone,
drop one pill, so that now, instead of 8
pills a day, you will be taking 7, or if you
were taking 9 pills a day, you will be
2. Wait 4 or 5 days, a week if you wish. If
you see no change in your milk supply, drop
3. Wait another 4 or 5 days. If you see no
change in your milk supply, drop another
4. Continue in this way until you are down
to no pills a day. If there has been no
decrease in your milk supply, or if there
has been a small decrease that does not
affect the breastfeeding and baby’s weight
gain, that’s just what we hope to have
happened, and many mothers manage this.
however, your supply diminishes
significantly, return to the
previous effective dose and do
not drop any pills for a couple
of weeks at least.
If you are
keen to go off the domperidone,
after a couple of weeks on the
same dose, start dropping a pill
a day, as in step 1 above. Some
mothers, who were not able to
get off the domperidone with
steps 1-4 above, can do it the
second or the third time.
find that you have to continue a
certain dose to maintain your
milk supply. But following steps
1-4 above will get you to the
lowest effective dose.
It is possible,
however, that after two weeks, you are not
where you want to be. In that case, you
should continue using the domperidone. If
you are still not where you want to be after
6 weeks of domperidone, it is time to think
some more about the domperidone. If you are
supplementing, and have managed to reduce
the amount of supplement from 14 ounces to
10 ounces, is it really worth taking a drug
in order to do this? If you feel it is, then
continue with the domperidone, but try
weaning the number of pills down to minimum
number that maintain your milk supply, as
above. If you do not feel it is worth it,
try weaning down as above, and if you don’t
see any change once you get to no pills a
day, fine. However, if you do notice a real
change in the milk supply as you lower the
dose, maybe the domperidone is more
effective than you had thought (remember,
after 6 weeks, your baby is significantly
heavier, and it may be that instead of
needing 14 ounces without domperidone, the
baby might actually need 20 ounces to
maintain good weight gain, in which case the
domperidone is actually doing something).
Remember: Before using domperidone,
the breastfeeding should be fixed, and as
quickly as possible. This means:
best latch possible. This alone
may result in the baby getting
compression to continue milk
intake by the baby.
one side before offering the
other (see protocol for
increasing breastmilk intake by
the baby for an explanation on
how to know the baby is getting
limit the baby to one side if
the baby is not getting enough.
Switch to the other side once
the baby is no longer getting
milk even with the compression.
and forth, as long as the baby
is getting good amounts of milk.
protocol for increasing
breastmilk intake by the baby.
About The Author: Dr. Jack Newman is a Toronto
pediatrician who has practiced medicine since 1970. In 1984 he established the
first hospital based breastfeeding clinic in Canada, at the Hospital for Sick
Children in Toronto. He now holds breastfeeding clinics in several Toronto area
hospitals. Jack has been a consultant with UNICEF's Baby Friendly Hospital
Initiative and has spoken at conferences around the world. He is the father of
three children, all breastfed.
Dr. Newman is the author of
"The Ultimate Breastfeeding Book of Answers"
NOTE: The article above titled "Domperidone-continued" was
written by Dr. Jack Newman and is the opinion of its author. "The New Parents Guide" does not guarantee the information to
be factual. Always use the guidance of your personal
doctor or your child's doctor over information you read on this site or elsewhere; your doctors know what is
best for you and your baby.