When would domperidone be prescribed?

Domperidone may be prescribed to increase milk production in breastfeeding/chestfeeding individuals. Domperidone will only be prescribed after other strategies have been tried. Feeding support, feeding technique, and adequate parent nutrition should all be tried before medication.

• How do I access feeding support? The first steps to increase milk production are support, education, and assessing feeding technique. Here are some resources to access more support:
  • Saskatchewan Lactation Consultants
  • HealthLinkBC Breastfeeding and Your Milk Supply
  • La Leche League Canada

How does domperidone work?

Domperidone is typically used to treat digestive disorders. A potential side effect of domperidone is it produces prolactin, a hormone that helps establish milk supply. Once milk supply is established, prolactin is less important in maintaining lactation. Because of this side effect, domperidone has been prescribed off-label* to help increase milk supply in breastfeeding/chestfeeding individuals.

*Off-label: prescribing a drug for a condition it hasn’t been officially approved for by Health Canada. Prescribing off label may be considered safe when there is strong evidence to support it. A Canadian study found that 11% of medications are prescribed off label.

What dose of domperidone will I be prescribed?

A recommended dose for domperidone to increase milk supply is not well studied. You should know that:

• Common doses are based on the experience of doctors who use domperidone, and a small number of studies.
• It is recommended to start domperidone at 10 mg three times a day.
• Domperidone should be taken at its lowest effective dose for the shortest period of time.
• Your prescriber will recommend a dose that is specific for you.

How do I know if domperidone is working?

Domperidone does not start to work at the same time for everyone. It may start to work within a day, 2 weeks or not at all. Increased milk production may look like infant weight gain, more wet and dirty diapers, longer time at the breast/chest and more pumped milk. Plan with your lactation consultant how to monitor if domperidone is working.  

Who should NOT take domperidone?

• People with heart issues (e.g., heart failure, prolonged QT, etc.) as domperidone may increase the risk of serious abnormal heart rhythms.
• People taking medications that interact with domperidone as some medications taken with domperidone can be risky due to drug interactions.

Ask your healthcare professional if domperidone is safe for you.

Are there side effects for myself? What about my baby?

Parent: Side effects are uncommon. Side effects can be dry mouth (2%), headache (≤1%), migraines (≤1%) and less commonly include stomach upset, dizziness, irritability, and fatigue.

• Abnormal heart rhythm with domperidone is rare. Symptoms of serious abnormal heart rhythm include: dizziness, palpitations, low heart rate, shortness of breath or fainting. If you experience these symptoms seek emergency medical attention.

Baby: Domperidone is not reported to cause side-effects in babies and is considered compatible with breastfeeding/chestfeeding.

How do I stop domperidone?

Domperidone should never be stopped suddenly. A plan to taper off of domperidone should be made with your prescriber. Stopping suddenly can cause withdrawal symptoms including insomnia, agitation, anxiety, panic attacks, and depression.

• If you no longer wish to breastfeed/chestfeed, a taper is still recommended.
• Once milk supply is established, tapering off the medication should be attempted.
• To stop domperidone:
  • Taper gradually. Reduce the dose by 1 tablet every 4-7 days. Your prescriber may adjust the taper depending on how you feel while stopping.
  • Watch for signs of withdrawal. Tell your healthcare provider as soon as possible if you notice any symptoms.
  • Watch for signs of decreased milk supply if you continue to breastfeed/chestfeed. If supply has decreased, continue taking domperidone at the previous dose that worked and contact your healthcare provider

Why is domperidone in the news?

• In December 2022, a Canadian news agency reported on the use of domperidone for breastfeeding/chestfeeding and the withdrawal effects that people have experienced when stopping it.
• Health Canada is doing a safety review to look into withdrawal symptoms.
• Safety reviews are a regular part of what Health Canada does to make sure medications are safe. The results of the safety review will be shared so that people and healthcare providers can make informed choices.

Contact medSask at 1-800-665-3784, 306-966-6378 or med.sask@usask.ca with questions about domperidone.