Will taking domperidone help you make more breast milk?

The medication known as domperidone increases the amount of breast milk you can produce if your baby is born prematurely. Domperidone also plays an important role if you are a person who is inducing lactation of your breasts. You can find out about inducing lactation here. However, there isn't reason to believe that domperidone increases the amount of breast milk you produce if you have a term baby, and it does cause side-effects for many women. This article deals with breastfeeding women whose babies aren't born prematurely. Please discuss whether or not to use domperidone with your own GP or other prescribing doctor.

What is domperidone and how safe is it?

Dopamine, which also causes feelings of reward and pleasure, is one of various factors which dial down prolactin production. It’s believed that the medication domperidone binds with dopamine receptors, blocking dopamine from bonding with those receptors, which decreases the effects of dopamine and allows prolactin secretion to increase.

Numerous studies provide reassuring evidence of domperidone’s basic safety in breastfeeding women, although you'll see further down that domperidone has significant side-effects for many women. However, domperidone should be avoided or used with extreme caution if you are a breastfeeding woman who

1. Has a personal or family history of cardiac arrhythmia

2. Has a family history of unexplained sudden death

3. Takes medications which inhibit metabolism of domperidone, or

4. Takes medications which are known to increase the risk of electrical abnormalities in the heart. The list of these medications includes the antibiotic erythromycin and also the anti-fungal known as fluconazole (or diflucan). I showed in a research paper published in 2021 that fluconazole is often unnecessarily prescribed for breastfeeding women with lactation-related nipple pain. You can find out about thrush and nipple pain here.

The anti-depressant known as citalopram and escitalopram may increase electrical conductions in the heart in some women, but the commonly used anti-depressant known as sertraline (or zoloft) doesn't. Please discuss domperidone use with your GP or prescribing doctor.

Will domperidone increase the amount of breast milk you can make?

If your GP or other doctor prescribes domperidone for your milk supply, the dose will be either one or two 10 mg tablets, three times a day. Although much larger doses have been used internationally, these put women at increased risk of side-effects without any evidence of benefits.

You can find out about the research into domperidone use here.

Yes, if your baby is born prematurely

Breasts requires high levels of prolactin to mature into lactation, and a preterm baby is born before this biological process can complete. It makes sense, then, that research shows women whose babies are born prematurely are able to increase their milk production by an average of 90 mls in a 24-hour period by taking domperidone. It seems that the increased levels of prolactin which result when you take domperidone help ripen your milk glands into full maturity.

As long as your doctor has given you the all clear that you're not at increased risk of side-effects, taking domperidone is usual in this situation, to help you produce milk.

No, if you have a term baby

If you gave to your baby at term, your milk gland tissue is fully mature. Your prolactin levels were very high at the time of the birth, but from 30-40 hours after giving birth, your milk synthesis is under the control of how frequently and effectively milk is removed from your breasts.

There isn't any reliable evidence to prove that domperidone use increases milk supply in mothers of term babies. Also, here are some reasons why domperidone isn't likely to help.

• From 30-40 hours after the birth, prolactin levels don't correlate with the amount of milk you make or the rate at which you can make milk.

• Full milk production is reached by a out two weeks after the birth, and remains stable from when the baby is one month to six months of age in successfully and exclusively breastfeeding mothers and babies.

• But prolactin levels are gradually dropping off as the days, weeks and months pass even in women who are successfully and exclusively breastfeeding. But your milk volumes are not being driven by, or responding to, prolactin levels.

• Volumes of milk produced by successfully and exclusively breastfeeding women vary between 600 and 1300 mls in a 24-hour period.

Even if we imagined that your milk supply could increase by 90 mls/day, which happens for mothers of preterm babies, that extra five or so mls each breast per feed over a 24-hour period (which matters for a tiny premmie) is about the equivalent to some milk leaking from your breasts or dribbling out of the baby’s mouth each feed. It might be equivalent to the amount of milk baby loses in pukes. There is a great deal of buffering in milk supply - there is no need to worry about the loss of some breast milk in leaks or in baby's vomits, so that 90 mls extra is neither significant or helpful.

The calibration of milk supply to the baby’s need is a biological system which has a great deal of inbuilt buffering. You can find out why its best to think of you and your baby as the one biological system here.

What are possible side-effects of domperidone?

It's been shown that almost half of breastfeeding women taking domperidone report side-effects. These include

• Weight gain

• Headache

• Fatigue

• Irritability

• Depression.

It's important to stop taking domperidone slowly, over a couple of weeks

If you have been taking domperidone and are ready to stop, it's very important to taper your dose down slowly, over a couple of weeks depending on the dose you've been on. Please talk this over with your GP or prescribing doctor. Gradual reduction avoids the risk of domperidone withdrawal side-effects such as depression, anxiety, and insomnia.

Why is domperidone so commonly prescribed for breastfeeding women?

In the past decade or so, the number of prescriptions written for domperidone have doubled, particularly in high income countries like Australia, Canada and the UK. Breastfeeding women are more likely to use domperidone with their firstborns, and the research shows that most stay on domperidone for months.

The research shows that as health professionals, we do have a tendency to over-estimate the benefits of a pharmaceutical intervention, and to underestimate side-effects.

However, I believe domperidone is taken by so many breastfeeding women and for such long durations because women are profoundly committed to making breastfeeding work for their babies, and are willing to try anything reasonably safe in the hope it might help. In Possums Breastfeeding & Lactation, I aim to show you that there are many other effective ways of ensuring your milk production when your baby is born at term, without you feeling you need to try domperidone.

Selected references

Grzeskowiak LE, Dalton JA, Fielder AL. Factors associated with domperidone use as a galactogogue at an Australian tertiary teaching hospital. Journal of Human Lactation. 2015;31(2):249-253.

Smolina K, Morgan SG, Hanley GE, Oberlander TF, Mintzes B. CMAJ Open. 4. 2016;1(e13-19).

Mehrabadi A, Reynier P, Platt RW, Fillion KB. Domperidone for insufficient lactation in England 2002-2015: a drug utilization study with interrupted time series analysis. Pharmacoepidemiol Drug Saf. 2018;27(12):1316-1324.

McBride GM, Stevenson R, Zizzo G, Rumbold AR, Amir LH, Keir AK, et al. Use and experience of galactogogues while breastfeeding among Australian women. Plos One. 2021;16(7):e0254049.

Hale TW, Kendall-Tackett K, Cong Z. Domperidone versus Metocloopramide: self-reported side effects in a large sample of breastfeeding mothers. Clinical Lactation. 2018;9(1).

Douglas PS. Overdiagnosis and overtreatment of nipple and breast candidiasis: a review of the relationship between the diagnosis of mammary candidiasis and Candida albicans in breastfeeding women. Women’s Health. 2021;17:DOI: 10.1177/17455065211031480.

Park S-I, An H, Kim A, Jang I-J. An analysis of QTc prolongation with atypical antipsychotic medications and selective serotonin reuptake inhibitors using a large ECG record database. Expert Opinion on Drug Safety. 2016;15(8):1013-1019.

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.

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.

Hoffman T, Del Mar C. Patients’ expectations of the benefits and harms of treatments, screening and tests – a systematic review. JAMA Internal Medicine. 2015;175(2):274-286.

Hoffman T, Del Mar C. Clinicians’ expectations of the benefits and harms of treatments, screening, and tests – a systematic review. JAMA Internal Medicine. 2017;177(3):407-419.

Seeman P. Yes, breast is best, but taper domperidone when stopping. British Journal of General Practice. 2014.

Papastergiou J, Abdallah M, Tran A. Domperidone withdrawl in a breastfeeding woman. Can Pharm J (Ott). 2013;146:210-212.

Doyle M, Grossman M. Case report: domperidone use as a galactagogue resulting in withdrawal symptoms upon discontinuation. Archives of Womens Mental Health. 2018;21(4):461-463.