Taking domperidone

How do I take domperidone and how do I stop it?

Domperidone has not been approved by any government for use to increase the milk supply. The availability of domperidone varies from country to country. It is available in some without a prescription; others require one. It is not sold in the United States. Several organizations recommend that if it is to be used, the amount should be no more than 30 milligrams a day because the risk of heart trouble increases at higher dosages. Our clinic usually starts with a one-week trial and recommends stopping if the milk supply does not increase significantly in that time. Mothers should stop using domperidone when it is no longer helping. To do this, they can stop taking if for a few days and monitor their milk supply; if it decreases, they can resume it. They should try to stop domperidone after the first month of use and at least every three months afterward. Mothers should also stop using domperidone if they have side-effects.   

A) Obtaining domperidone

Domperidone is a medication that is sometimes used to increase milk supply. The availability of domperidone varies from country to country. It is available in some countries without a prescription; others require one. Domperidone has not been approved by any country as a drug to increase milk supply.

The U.S. Food and Drug Administration (FDA) has not approved its use for any reason and it is not available in the U.S. The FDA has also issued advisories against the use of domperidone to increase milk supply (Sewell 2017).

B) Domperidone dose

The risk of a person’s heart rhythm changing increases at dosages over 30 milligrams a day and there is no evidence currently that an increased dose is more effective (Knoppert 2013).

Health Canada and the European Medicines Agency's Pharmacovigilance Risk Assessment Committee recommend taking 10 mg orally three times a day and no more (Health Canada 2017; PRAC 2014).

The pill is taken about one-half hour before meals.

C) Starting domperidone

Domperidone should only be taken if:

Some health-care providers will arrange for a heart rhythm test (electrocardiogram [EKG or ECG]) for individuals at higher risk of heart rhythm abnormalities before or after starting domperidone (Health Canada 2017).

Domperidone should not be started before the milk comes in but can be used at any time afterwards (Asztalos 2019).

D) When to stop taking domperidone

Mothers should stop domperidone if they experience side-effects.

We usually recommend trying to stop the medication:

  • One week after starting, if the milk supply does not increase significantly.
  • After the first month of use to see if it is still effective.
  • At least every three months thereafter to see if it is still effective.

Some studies have recommended stopping domperidone after two weeks (Anderson 2017).

The length of time that domperidone is taken varies and the decision is often based on why the medication was started. Mothers should try stopping the medication if the problem is fixed. Examples include:

Some mothers need to continue domperidone if the problem is ongoing. Examples include a mother who:

E) How to stop taking domperidone

To stop domperidone, mothers stop taking it and monitor their milk supply; if it decreases, they should resume it. 

Domperidone levels in the body fall by one-half in about 16 hours and levels would be extremely low within 80 hours (3 1/3 days) of the last dose (Huang et al. 1986). Any changes, such as the breasts feeling less full or the baby seeming hungrier, are usually seen within a few days and certainly within a week of stopping it. 

We advise mothers to be ready to increase the baby’s milk supplements when stopping domperidone in case the supply drops and until they resume taking it.  

If the mother does not note any change in herself or in the baby in the week after stopping the medication, it is no longer helpful.

We usually stop domperidone abruptly. Some mothers find tapering (slowly decreasing) domperidone works better. However, it can be harder to notice a difference with tapering.

On rare occasions, stopping abruptly can produce side-effects. This may be more of a problem for mothers on doses above 30 mg per day. In this situation, mothers should taper the amount of domperidone very slowly. Please consult your health-care providers in such situations.

References

Anderson PO. Domperidone: the forbidden fruit. Breastfeeding Medicine 2017; 12(5)
 
Asztalos EV, Kiss A, daSilva OP, et al. Role of days postdelivery on breast milk production: a secondary analysis from the EMPOWER trial. Int Breastfeed J. 2019 Jun 4;14:21
 
Health Canada, Recalls and Alerts. Domperidone Maleate - Association with Serious Abnormal Heart Rhythms and Sudden Death (Cardiac Arrest) - For Health Professionals. Ottawa: Health Canada; 2017 Mar 14 [cited 2020 Sept 25]
 
Huang Y-C, Colaizzi JL, Bierman RH, et al. Pharmacokinetics and dose proportionality of domperidone in healthy volunteers. J Clin Pharmacol 1986;26:628-32.

Knoppert DC, Page A, Warren J, et al. The effect of two different domperidone doses on maternal milk production. J Hum Lact. 2013 Feb;29(1):38-44

PRAC recommends restricting use of domperidone. Pharmacovigilance Risk Assessment Committee (PRAC). London: European Medicines Agency; 2014 Mar 7

Sewell CA, Chang CY, Chehab MM, et al. Domperidone for Lactation: What Health Care Providers Need to Know. Obstet Gynecol. 2017 Jun;129(6):1054-1058