Domperidone for Breastfeeding / Chestfeeding

When would domperidone be prescribed?

Domperidone may be started to help increase milk supply after other strategies are not sufficient. Factors like feeding support, feeding technique, and adequate nutrition should be introduced before medication. 

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. Prescribing off label is 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. Here is what you need to know: 

  • Common doses are based on the experience of doctors who use domperidone, and the small studies that exist.
  • 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?

  • Individuals with underlying heart issues (e.g., heart failure, prolonged QT, etc.): Domperidone may increase the risk of serious abnormal heart rhythms. 
  • Individuals taking other medications: Some medications taken with Domperidone can 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 digestive symptoms, dizziness, irritability, and fatigue. 

  • Serious abnormal heart rhythm symptoms: dizziness, palpitations, low heart rate, shortness of breath or fainting. If you experience these symptoms seek emergency medical attention. 

Baby: Domperidone is not known 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 tapering plan should be created with your prescriber. Stopping abruptly can cause withdrawal symptoms including insomnia, agitation, anxiety, panic attacks, and depression. 
    • If you no longer wish to breast/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 wish to continue to breast/chestfeed. If supply has decreased, return to the previous successful dose, continue the medication, and contact your healthcare provider. 

Why is domperidone in the news?

  • In Dec 2022, a Canadian news agency reported on alarming withdrawal effects experienced by individuals who were prescribed medications to increase milk supply. In 2023, Health Canada did a safety review of domperidone being used to help increase milk supply and found that there is a risk of psychiatric side effects like depression, anxiety, and insomnia when people stop domperidone suddenly. In the small number of cases, the risk was higher in people taking more than 30 mg daily and in people who took domperidone for longer than 4 weeks.

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