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).