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Domperidone: Do and Do Nots


prescription pills

As a provider who specializes in low milk supply, the topic of Domperidone comes up often during interactions with clients. Yes, you can always ask me about it and I will be frank. My job is to provide factual, evidence-based information on the use, potential effects on lactation and risks so you can make informed decisions. No, I can’t prescribe it but if it’s an appropriate option for your situation, there are ways to acquire without a prescription. But when lactating people discover it’s fairly easily acquired without professional involvement and pursue on their own, there’s a missed opportunity for education.

 

Domperidone is a dopamine-2 antagonist and sometimes used as a galactagogue. This is considered an off-label use. It is not FDA approved in the United States but is commonly used in other countries like Canada and Australia. Dosages in lactation tend to be higher than what has been studied for original indications. With that said, I feel a duty to get some safety info out there even if you’re not my client. There’s so much advice out there in the digital world that often lacks the safety net of professional guidance. Mom-to-mom groups and other online resources can be a convenient source of support, especially for low supply, but I would be very cautious of any medical interventions recommended to boost supply. There is no magic pill. Let me repeat, there is no magic pill. Everything has risks. Low supply is a complex issue that usually has more than one underlying factor and interventions should be targeted at the root cause.

 

If you don’t know the root cause of your supply issues, it’s difficult to determine what might work. There is no “one size fits all” approach and professional guidance and an individualized management plan is the first step when you can’t move things in the right direction on your own. I often see Domperidone recommended in various online sources by professionals and non-professionals. Yes, it has worked for others. Yes, it may be an option for you. But, please learn everything you can. You must be aware of potential safety issues. They’re rare but they do happen…  

 

DO schedule a full feeding evaluation with an IBCLC.

  • This should be your FIRST step in investigation anytime you suspect low supply.

  • Galactagogues do not replace evaluation by a profession and counseling.

  • Galactagogues should only be considered after lactation has been optimized.

 

DO get your prolactin levels checked (domperidone works by increasing prolactin levels).

  • Have you had your prolactin levels checked?

  • Was the timing of the lab draws appropriate to catch the baseline level AND surge?

  • Were your levels interpreted based on your number of weeks postpartum?

  • FYI: The reference range provided on your lab report is irrelevant if you are lactation.

  • Were your prolactin levels below the optimum range for lactation?

If you cannot answer yes to all above, then Domperidone is not an appropriate consideration for your overall plan for supply improvement. If your prolactin levels are normal, it’s not going to do anything to boost your supply.

 

DO learn about the cardiac risks and get appropriate cardiac screening.

  • There is a risk of QT prolongation in certain individuals that take Domperidone.

  • This is a serious potential side effect that can be life threatening.

  • I recommend anyone that anyone who is considering Domperidone have a baseline EKG and regular monitoring if you continue Domperidone long term.

  • Your usual healthcare provider may or may not be willing to do this for you. If you have a cardiologist, you have likely had an EKG done already and you should absolutely be discussing this medication with your specialist if you have any underlying cardiac concerns.

 

DO have a plan for weaning of the medication before you start.

  • Weaning off Domperidone (especially at higher doses) should be done very slowly and most people are not aware of this. It’s not a med you can just stop.

  • In general, the weaning process is to decrease by 1 pill every 4-7 days. The slower the better and this means weaning off completely can take 4-8 weeks.

  • You need to be aware of this long drug weaning period BEFORE you even start. There is no fast way to get off of it and people are unaware of this.

  • There is a risk of psychiatric side effects with rapid weaning including: anxiety, depression, intrusive thoughts and suicidal ideations.

 

DO NOT take Domperidone without talking to your health care provider if you have:

  • A psychiatric condition (including postpartum depression)

  • A condition that can cause bowel blockage like Crohn’s disease or diverticulitis

  • Recent abdominal surgery (including cesarean section)

  • A history of bleeding in your stomach or gut

  • Pituitary tumor

  • Liver or kidney problems

  • Irregular heartbeat (arrhythmia) or heart problems.

 

In conclusion, Domperidone has been used safely by many lactating people looking to boost supply in certain situations. It is not FDA approved in the US and does have a significant side effect profile that may affect certain individuals. If you are experiencing low supply and considering pharmaceutical support, please discuss with your IBCLC, your usual provider or Lactation Medicine specialist.

 

For more information on Domperidone from Lactmed: https://www.ncbi.nlm.nih.gov/books/NBK501371/


Jennifer Gerard, APRN, FNP, IBCLC


Information presented is educational only and not to be taken as medical advice. If you have specific questions about low milk supply investigation or would like to do labwork, let’s do a video visit and talk about it!



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