What does the research tell us about domperidone use for low supply?

Women use domperidone because they care deeply about breastfeeding their babies

Zizo et al write:

"If women are allowed to have unrealistic expectations about domperidone use, this has possible negative impacts on maternal agency, confidence, anxiety and self-efficacy, with negative psychological sequelae” 1

This observation correlates with my own clinical experience over many years.

What does the research say about the effects of domperidone on milk production?

A 2021 systematic review of 16 randomised controlled trials concludes that for mothers of preterm babies with low milk supply, domperidone increased daily milk volumes by on average 90 mls, without significant side-effects. The longest clinical trial lasted 28 days, and the evaluations were mostly conducted over 7-14 day period.2 There is inadequate data to show whether or not these increased volumes improved breastfeeding duration or infant weight gain.

Nevertheless, domperidone prescription is best practice in the care of mothers of preterm infants who plan to breastfeed. The breast requires high levels of prolactin to mature into lactation, and a preterm baby was born before this biological process could complete. For most mothers of preterm babies, potential benefits outweigh potential risks.

That same systematic review concludes there isn’t enough evidence to support the use of domperidone in mothers of term babies.2 Another 2020 systematic review agrees,3 as does the 2018 Academy of Breastfeeding Medicine guidelines.4 The only two relevant studies are methodologically weak, conducted in the days immediately after birth, and of only one or four days duration.5,6

Si et al 2024

This network meta-analysis of 17 randomized controlled trials (RCTs) found that domperidone

• Increased milk volume by 82.84 mL/day compared to metoclopramide and 88.30 mL/day compared to placebo in preterm mothers

• Did not show a significant benefit in increasing breast milk volume compared to metoclopramide or placebo in term mothers.

What do mothers who are breastfeeding term babies say about domperidone use?

Two qualitative studies (n = 22, n = 15) of Australian breastfeeding mothers confirm what I’ve often heard women say over the years in the clinic.13, 14 These women are not looking for a panacea or ‘magic remedy’ but make the strategic decision to use galactagogues alongside various other strategies for increasing supply. They do this and are willing to risk side-effects because breastfeeding their baby is very important to them.

The authors conclude that women turn to domperidone in large numbers because our health system is unable to effectively deliver accurate information and effective clinical support for lactating women.1,7

Their studies found that breastfeeding woman

• Receive large amounts of conflicting and confusing advice about supply concerns

• Feel dismissed by their GP or health professional when raising supply concerns

• Are stressed about low supply concerns

• Feel an urgent need for something that will help

• Feel more in control of supply when using domperidone

• (Inaccurately) believe domperidone produces quick results, anticipating high volumes and steady increases

• Are afraid to stop domperidone because they feel this would risk their supply

• Use domperidone for long periods and self-adjust dosages

• Have not been informed about the need to taper off.1,7

References

1. Zizzo G, Rumbold AR, Grzeskowiak LE. ‘Fear of stopping’ vs ‘wanting to get off the medication’: exploring women’s experiences of using domperidone as a galactagogue – a qualitative study. International Breastfeeding Journal. 2021;16:92.

2. Shen Q, Khan KS, Du M-C, Du W-W, Ouyang Y-Q. Efficacy and safety of domperidone and metoclopramide in breastfeeding: a systematic review and meta-analysis. Breastfeeding Medicine. 2021:doi: 10.1089/bfm.2020.0360.

3. Foong SC, Tan ML, Foong WC, Marasco LA, Ho JJ, Ong JH. Oral galactogogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants (Review). Cochrane Database of Systematic Reviews. 2020(5):Art. N.:CD011505.

4. Brodribb W, Academy of Breastfeeding Medicine. ABM Clinical Protocol #9: use of galactagogues in initating or augmenting maternal milk production. 2018.

5. Jantarasaengaram S, Sreewapa P. Effects of domperidone on augmentation of lactation folowing cesarean delivery at full term. International Journal of Gynecology and Obstetrics. 2012;116:240-243.

6. Inam I, Hasmi AB, Shahid A. A comparison of efficacy of domperidone and placebo among postnatal women with inadequate breast milk production. Pak J Med Health Sc. 2013;7:314-316.

7. Zizzo G, Amir LH, Moore V, Grzeskowiak LE, Rumbold AR. The risk-risk trade-offs: understanding factors that influence women’s decision to use substances to boost breast milk supply. Plos One. 2021;16(5):e0249599.