Domperidone (Motilium™) is a drug that has, as a side
effect, stimulating or increasing milk production, probably by increasing
prolactin production by the pituitary gland. Prolactin is the hormone that
stimulates the cells in the mother's breast to produce milk. Domperidone
increases prolactin secretion indirectly, by interfering with the action of
dopamine whose action is to decrease the secretion of prolactin by the pituitary
gland. Domperidone is generally used for disorders of the gastrointestinal tract
(gut) and has not been released in Canada for use as a stimulant for milk
production. This does not mean that it cannot be prescribed for this reason, but
rather that the manufacturer does not back its use for increasing milk
production. However, there are several studies that show that it works to
increase milk production and that it is safe. It has been used, for several
years, in small infants who spit up and lose weight, but was replaced until a
few years ago by cisapride (Prepulsid™) (cisapride has since been taken off the
market because it can cause serious cardiac problems). Domperidone is not in
the same family of medication as cisapride and has never had the cardiac side
effects that cisapride does. Another, related, but older medication,
metoclopramide (Maxeran™), is also known to increase milk production, but it has
frequent side effects which have made its use for many nursing mothers
unacceptable (fatigue, irritability, depression). Domperidone has many fewer
side effects because it does not enter the brain tissue in significant amounts
(does not pass the blood-brain barrier).
is it appropriate to use domperidone?
Domperidone must never be used as the first approach to correcting
breastfeeding difficulties. Domperidone is not a cure for all things. It
must not be used unless all other factors which may result in
insufficient milk supply have been dealt with first. These include:
Correcting the baby's latch so that the baby can obtain as efficiently as
possible the milk which the mother has available. Correcting the latch may be
all that is necessary to change a situation of "not enough milk" to one of
"plenty of milk".
breast compression to increase the intake of milk (Breast Compression).
milk expression after feedings to increase the supply.
4. Correcting sucking problems, stopping the use of artificial nipples (Using a Lactation Aid and
Finger Feeding) and other stratagems.
domperidone for increasing milk production:
Domperidone works particularly well to increase milk production under the
It has frequently been noted that a mother
who is pumping milk for a sick or premature baby in hospital has a
decrease in the amount she pumps around 4 or 5 weeks after the baby is
born. The reasons for this decrease are likely many, but domperidone
generally brings the amount of milk pumped back to where it was or even
to higher levels
When a mother has a decrease in milk
supply, often associated with the use of birth control pills (avoid
estrogen containing birth control pills while breastfeeding), or on
occasion, for no obvious reason when the baby is 3 or 4 months old, domperidone will often bring the supply back to normal
Domperidone still works, but often less dramatically when:
The mother is pumping for a sick or
premature baby but has not managed to develop a full milk supply
The mother is trying to develop a full
milk supply while nursing an adopted baby
The mother is trying to wean the baby from
effects of domperidone:
all medications, side effects are possible, and many have been reported with
domperidone (textbooks often list any side effect ever reported, but symptoms
reported are not necessarily due to the drug a person is taking). There is no
such thing as a 100% safe drug. However, our clinical experience has been that
side effects in the mother are extremely uncommon, except for increasing milk
supply. Some side effects which mothers we have treated have reported (very
amount that gets into the milk is so tiny that side effects in the baby should
not be expected. Mothers have not reported any to us, in many years of use.
Certainly the amount the baby gets through the milk is a tiny percentage
of what babies would get if being treated for spitting up.
Are there long term concerns about the use of domperidone?
manufacturer states in its literature that chronic treatment with
domperidone in rodents has resulted in increased numbers of breast tumours in
the rodents. The literature goes on to state that this has never been documented
in humans. Note that toxicity studies of medication usually require treatment
with huge doses over periods of time involving most or all of the animal's
lifetime. Note also that not breastfeeding increases the risk of breast
cancer, and breast cancer risk decreases the longer you breastfeed.
Generally, we start domperidone at 20 milligram's (two 10 mg tablets) four times
a day. If taking domperidone 4 times a day is inconvenient, 30 milligram's
(three 10 mg tablets) three times a day is fine. Printouts from the pharmacy
often suggest taking domperidone 30 minutes before eating, but that is because
of its use for digestive intolerance. You can take the domperidone about every 6
hours, when it is convenient (there is no need to wake up to keep to a 6 hour
schedule—it does not make any difference). Most mothers take the domperidone for
3 to 8 weeks. Mothers who are nursing adopted babies may have to take the drug
After starting domperidone, it may take three or four days
before you notice any effect, though sometimes mothers notice an effect within
24 hours. It appears to take two to three weeks to get a maximum effect, but
some mothers have noted effects only after 4 or more weeks. It is reasonable to
give domperidone a trial of at least 4 weeks before saying it doesn’t work.
Here is more
how to wean off the domperidone.
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" 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.