Domperidone and Breastfeeding

I have had more than my fair share of problems when it comes to breastfeeding my son. My milk did not come in until my son was 8 days old forcing us to supplement at the breast with syringes and feeding tubes. Then at my 8 week check up with my obstetrician he prescribed me the mini pill for birth control and told me that it would have no effect on my milk supply. I believed him and began taking the pill causing my supply to significantly plummet. I saw my son cry from hunger because my body was not able to produce the milk he needed, and I can only imagine few other things that would have broken my heart more. I immediately sought help at my local Baby Cafe. For those who don't know, the Baby Cafe is a charity organization that provides breastfeeding support to those who need it. The Baby Cafe I attend is also a local 'hang out' for breastfeeding mothers and their babies that has the most well known lactation consultant in my area. It is exactly the place I needed, and gave me the hope to successfully breastfeed my son at least to his first birthday.

I met with the lactation consultant who heard my battle stories and asked all the right questions. I had tried everything to bring my milk supply back: fenugreek, blessed thistle, Mother's Milk tea, drinking mass amounts of Gatorade, lactation cookies, pumping after every feeding, anything my research and other mothers I had spoken to suggested. I informed the lactation consultant of all my attempts and failures. Expecting to see the face of a woman as stumped as I was I was instantly surprised that her face still glowed with hope for me. She asked to be excused and returned with a book in hand: Medications and Mothers' Milk 2012 by Thomas W. Hale, Ph.D. She told me I was a perfect candidate for Domperidone and proceeded to tell me all about it.

Domperidone is primarily used as medication to combat nausea, vomiting and gastric reflux in chemotherapy patients. It also causes significant increases in prolactin levels and can be used as a very effective galactagogue. A galactagogue is a substance that increases or promotes a milk supply.

It is currently used in Canada and lacks FDA approval in the US due to old research that suggests it causes heart arrhythmia. What is obvious to me, that the FDA seems to not bear in mind, is that the research was performed with sick patients undergoing chemotherapy and taking high dosages of Domperidone intravenously. As long a person does not have any previous issues with heart arrhythmia, is not hypokalemic, and sticks within the safe dosage there are no real risks reported. The best part is that there are absolutely no reported side effects or concerns for the breastfeed infant. It is used sometimes even used to treat infant reflux in the UK and Canada. Domperidone is the ideal galactagogue!
There are other medications used in the US that can increase a woman's milk supply, primarily Reglan is prescribed. The problem with Reglan, however, is that it can enter the brain and is known to cause depression. Personally I feel that proscribing a medication with such a side effect to women that have recently given birth and have hormones already all over the place is incredibly risky. So why will the FDA not reevaluate Domperidone? Why are doctors so hesitant to prescribe the drug in the US, despite the research suggesting it is risky is outdated and inaccurate?

A woman's prolactin levels increases from 8.1 ng/mL to 124.1 ng/mL for non-lactating women after ONE 20 mg dose. In every report prolactin levels and milk production increased for the majority of women. Although the breast milk protein levels decreased slightly in one study, it showed that caloric content, fat, carbohydrate, sodium or phosphate contents all remained the same for those taking Domperidone. The same study showed an increase in milk-carbohydrate and a very high increase calcium in the breast milk of those treated with the drug.

So where's the negative?


The draw back is that very few doctors stateside are willing to prescribe Domperidone. I had a horrible time trying to find a doctor that even knew what the drug was. I called my OB/GYN, I called my primary care physician, I called the physician the lactation consultant at the Baby Cafe recommended, I even called my sons pediatrician. No one was willing to help me, and with my supply so low, I had to start supplementing with formula again. In the end I was able to get the prescription and noticed a difference within 2 days of taking the pills.

I have been taking Domperidone for about 7 1/2 months now. Despite the fact that research suggests once the milk supply is established it is safe to wean off the medication I still take a single dose of 10 mg a day 'just in case'. The lactation consultant told me that she knows women that have taken it for years with no harm done, so I'm not worried. I am comfortable enough with the research I have done to trust that taking Domperidone will do no harm to me, just like the occasional cup of Mother's Milk tea, lactation cookie, or glass of Gatorade I have been know to partake in despite my supply being well established again. After all, I really just want what is best for my son, and I know that breast milk is really what is best.

My hope is that the FDA reevaluates Domperidone, that more physicians are willing to do their own research to educate themselves about drugs instead of prescribing the usual medications or suggesting horrible alternatives like 'just switch to formula' and most of all I hope more women are able to reap the benefits that this drug has to offer when they are as desperate as I was. This drug recovered my milk supply, gave me back hope, and has helped me provide my son with the best start possible.