Domperidone Frequently Asked Questions

Introduction

Domperidone (Motilium™) is a drug that has, as a side effect, stimulating or increasing milk production, probably by increasing prolactin production by the pituitary gland. Prolactin is the hormone that stimulates the cells in the mother’s breast to produce milk. Domperidone increases prolactin secretion indirectly, by interfering with the action of dopamine, whose action is to decrease 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. However, there are several studies that show that it works to increase milk production and that it is safe. It has been used, for several years, in small infants who spit up and lose weight, but was replaced until a few years ago by cisapride (Prepulsid™). Cisapride has since been taken off the market because it can cause serious cardiac problems. Domperidone is not in the same family of medication as cisapride and has never had the cardiac side effects that cisapride does. 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 unacceptable for many nursing mothers (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).

Medical Conditions and the Protocols

Previous history of thrombosis, cardiac condition, and severe hypertension are contraindications for the birth control pill portion of the protocols. Several women on the protocols who have been diagnosed with mild hypertension have responded well to Aldomet (methyldopa) enabling them to take the birth control pill. This medication has the added benefit of further increasing milk supply and is approved by the American Academy of Pediatrics for use in breastfeeding mothers.

Several women on the protocols with a history of depression have responded well to Zoloft (sertraline). Several studies indicate that this medication is compatible with breastfeeding.

Inability to tolerate the birth control pills is a concern for some mothers. Several women have tried estrogen patches, external lotions, and progesterone creams together with the domperidone.

Fenugreek has been reported to affect serum glucose levels. Therefore, diabetic mothers are advised to use this herb with caution.

Fenugreek can aggravate asthmatic symptoms. Mothers with a history of asthma are also advised to use this herb with caution.