Reasons for taking domperidone

Should I use domperidone?

There is little research on the effectiveness of domperidone in increasing milk supply. Our clinic has found that its effectiveness depends on the cause of the low supply. Mothers and their health-care providers need to weigh the risks and benefits of using domperidone. It should only be used if it is effective in increasing supply and if its use benefits the baby. It should not be used if the mother experiences side-effects or is at increased risk of developing them.

A) Likelihood of domperidone being effective

Domperidone is a medication that is sometimes used to increase milk supply. There is only a small amount of research on the effectiveness of domperidone in increasing milk supply (Hondeghem 2017).

In our clinic, we have found that the ability of domperidone to increase supply depends on the cause of the low supply. The following table is a summary of our experience.

Table: Likelihood of Responding to Domperidone

Response to domperidone

Reasons for low milk supply

Likely

An early return of periods

Use of certain medications

Use of hormonal birth control

Long night sleeps

Possible

Lack of breast stimulation

Postpartum hemorrhage

Retained placental fragment

Premature birth

Unlikely

Insufficient glandular tissue

Breast reduction surgery

Other major breast surgery

Nipple piercings

Severe malnutrition

B) When to use domperidone

Around six weeks of age, this baby started sleeping six to eight hours at night. At eight weeks, his mother’s menses returned. The mother’s milk supply soon decreased and by three months, the baby’s feeding patterns and behaviour and changed and the baby stopped gaining appropriately. The mother’s milk supply increased dramatically after starting domperidone and the baby began behaving and growing well.

Domperidone should only be used if:

  • It is definitely effective in increasing milk supply.
  • Its use will benefit the baby.
  • The mother is not at an increased risk of side-effects.
  • The mother and the baby do not experience any side-effects.
  • The mother is not taking any medications or citrus fruits that can increase the risk of side-effects.

C) Comparing effectiveness of the medication and the benefits for the baby

1) Example 1: When domperidone use is unlikely to benefit the baby

Consider a mother of a two-month-old baby who has a very low milk supply and can only make 250 millilitres (8 U.S. fluid ounces) a day. Even if domperidone increased her milk supply by 20%, she would still make only 300 ml (10 oz) a day. Her baby needs roughly 800 ml (27 oz) each day to grow well and would still need about 500 ml (17 oz) of milk supplement.

The increase in the mother’s milk production would not substantially decrease the amount of supplement this baby would need. The medication would have been effective but the benefits for the baby would be very limited. Given the risks of side-effects with medication and the benefits of a small increase in milk production, we would advise this mother to stop the medication.

2) Example 2: When domperidone use would benefit the baby

Consider the same mother. However, if her baby were premature and very small (for example, weighing 2,000 grams or 4 lb 6 oz) and only needed 300 ml (10 oz) of milk a day, the use of domperidone would allow the baby to receive only the mother’s milk and avoid other milk.

In this case, there are definite benefits for the baby. We would recommend that this mother continue with domperidone until it is no longer helpful.

References

Hondeghem LM, Logghe NH. Should Domperidone be Used as a Galactagogue? Possible Safety Implications for Mother and Child. Drug Saf. 2017 Feb;40(2):109-113