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by Jack Newman, MD, FRCPC

Domperidone (Motilium) is a drug which has, as a side effect, the increased production of the hormone prolactin. Prolactin is the hormone which stimulates the cells in the mother's breast to produce milk. Domperidone increases prolactin secretion indirectly, by interfering with the action of dopamine. One of the actions of dopamine is that it decreases 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. It has been used, for several years, in small infants who spit up and lose weight, but it has recently been replaced for this reason by a newer drug called cisapride (Prepulsid). Domperidone's ability to increase milk production has been recognized since it first became available. 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).

When 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:

1. 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”.

2. using breast compression to increase the intake of milk.

3. using milk expression after feedings to increase the supply.

4. correcting sucking problems, stopping the use of artificial nipples and other stratagems.

Using domperidone for increasing milk production

Domperidone works particularly well to increase milk production under the following circumstances:

  • 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 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 supplements.
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