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:
- 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".
- Using breast compression to increase the intake of milk (handout
#15 Breast Compression).
- Using milk expression after feedings to increase the supply.
- Correcting sucking problems, stopping the use of artificial
nipples (handout #5, Using a Lactation Aid, and #8, Finger Feeding)
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
- 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.
Side effects of domperidone:
As with all medications, side effects are possible, and many have
been reported with domperidone (textbooks often list any side effect
ever reported, but symptoms reported are not necessarily due to
the drug a person is taking). There is no such thing as a 100% safe
drug. However, our clinical experience has been that side effects
in the mother are extremely uncommon, except for increasing milk
supply. Some side effects which mothers we have treated have reported
(very uncommonly, incidentally):
- dry mouth
- headache which disappeared when the dose was reduced
- abdominal cramps
The amount that gets into the milk is so tiny that side effects
in the baby should not be expected. Mothers have not reported any
to us, in many years of use. Certainly the amount the baby gets
through the milk is a tiny percentage of what babies would get if
being treated for spitting up.
Are there long term concerns about the use of
The manufacturer states in its literature that chronic treatment
with domperidone in rodents has resulted in increased numbers of
breast tumours in the rodents. The literature goes on to state that
this has never been documented in humans. Note that toxicity studies
of medication usually require treatment with huge doses over periods
of time involving most or all of the animal's lifetime. Note also
that not breastfeeding increases the risk of breast cancer, and
breast cancer risk decreases the longer you breastfeed.
Generally, we start domperidone at 20 milligrammes (two 10 mg
tablets) four times a day. Printouts from the pharmacy often suggest
taking domperidone 30 minutes before eating, but that is because
of its use for digestive intolerance. You can take the domperidone
about every 6 hours, when it is convenient (there is no need to
wake up to keep to a 6 hour schedule—it does not make any difference).
Most mothers take the domperidone for 3 to 8 weeks. Mothers who
are nursing adopted babies may have to take the drug much longer.
After starting domperidone, it may take three or four days before
you notice any effect, though sometimes mothers notice an effect
within 24 hours. It appears to take two to three weeks to get a
After you have used domperidone for two weeks, we ask you to call
and ask for a return call. Based on your information, a decision
will be made what to do next. If you have unexplained symptoms at
any time call the same number immediately.
Handout #19. Domperidone.
Revised January 1998
Written by Jack Newman, MD, FRCPC
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