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How long can I
use domperidone?
When domperidone
was being used for babies (and now that
cisapride is off the market, it is being
used again), it was common for the babies
to be on the medication for several months.
Since the amount of domperidone that gets
into the milk is very small indeed, from
the baby’s point of view, there should
be no issue in the mother taking it to increase
milk supply for several months. Our experience
with this drug is that short-term side effects
are very few and almost always very mild.
Worldwide experience with domperidone over
at least two decades suggests that long-term
side effects also are rare. Some of the
mothers in our clinic, breastfeeding adopted
babies, have been on the medication for
18 months without any apparent side effects.
As mentioned in handout #19a Domperidone-1,
patients using domperidone for stomach disorders
may be on it for many years. I hope you
won’t need domperidone for very long,
but if it’s necessary and helpful,
stay on it.
How long does it take
for domperidone to work?
It depends on the
situation. In a situation where the mother
had had a good milk supply, but it decreased
for some reason (e.g. going on the birth
control pill, see handout #25 Slow
Weight Gain After the First Few Months),
domperidone often works very rapidly to
increase the milk supply. Often, within
a day or two the mother is seeing a difference
(and so does her baby). But this is not
always so, and in many situations, it may
take a week or more for the mother to start
getting an effect. On occasion, we have
had mothers only starting to get an increase
in their milk supplies a month or more after
starting to take it. Therefore, we generally
recommended that the mother take the domperidone
for at least six weeks in order to be sure
whether it has worked or not.
It is our impression that
domperidone works best after the first few
weeks after the mother has given birth (usually
after about four weeks). This has not been
proved, but there are theoretical reasons
why it may be so. For this reason, we have
often waited to prescribe it until the baby
is at least three weeks, mainly because
we did not want the mother to become discouraged
if she did not see any rapid increase in
her milk supply. But if you keep this in
mind, I have no problem prescribing it before
four weeks after the birth of the baby.
How do I know how long
to take domperidone?
Usually, we ask the mother
take it for two weeks and then re-evaluate
the situation. There are several possibilities.
- The milk supply has
increased substantially, to the point
where there is no longer a consideration
of using supplements, or the mother has
been able to stop supplements with the
baby continuing to gain well on breastfeeding
alone.
- The milk supply has
increased to a point that the mother feels
is satisfactory. For example, she may
still need to supplement, but the baby
does not fuss any more at the breast and
drinks contentedly.
- There has been little
or no effect with the Protocol to Increase
Breastmilk Intake by the Baby and the
domperidone. Often waiting or increasing
the dose may help.
In the first situation
(but not necessarily always in that situation),
we may suggest the mother start weaning
herself from the domperidone in this way:
1. Most mothers are taking
three tablets three times a day. When
you are ready to start weaning from the
domperidone, drop one pill, so that now,
instead of nine pills a day, you will
be taking eight..
2. Wait four or five days, a week if you
wish. If you see no change in your milk
supply, drop another pill.
3. Wait another four or five days. If
you see no change in your milk supply,
drop another pill.
4. Continue in this way until you are
down to no pills a day. If there has been
no decrease in your milk supply, or if
there has been a small decrease that does
not affect the breastfeeding and baby’s
weight gain, that’s just what we
hope to have happened, and many mothers
manage this.
- If, however, your supply
diminishes significantly, return to the
previous effective dose and do not drop
any pills for a couple of weeks at least.
- If you are keen to go
off the domperidone, after a couple of
weeks on the same dose, start dropping
a pill a day, as in step 1 above. Some
mothers, who were not able to get off
the domperidone with steps 1-4 above the
first time, can do it the second or the
third time.
- You may find that you
have to continue a certain dose to maintain
your milk supply. But following steps
1-4 above will get you to the lowest effective
dose.
It is possible, however,
that after two weeks, you are not where
you want to be. In that case, you should
continue using the domperidone. If you are
still not where you want to be after six
weeks of domperidone, it is time to think
some more about the domperidone. If you
are supplementing, and have managed to reduce
the amount of supplement from 14 ounces
to 10 ounces, is it really worth taking
a drug in order to do this? If you feel
it is, then continue with the domperidone,
but try weaning the number of pills down
to minimum number that maintain your milk
supply, as above. If you do not feel it
is worth it, try weaning down as above,
and if you don’t see any change once
you get to no pills a day, fine. However,
if you do notice a real change in the milk
supply as you lower the dose, maybe the
domperidone is more effective than you had
thought (remember, after six weeks, your
baby is significantly heavier, and it may
be that instead of needing 14 ounces without
domperidone, the baby might actually need
20 ounces to maintain good weight gain,
in which case the domperidone is actually
doing something).
Remember: Before
using domperidone, the breastfeeding should
be fixed, and as quickly as possible. This
means:
- Getting the best latch
possible. This alone may result in the
baby getting enough milk.
- Using compression to
continue milk intake by the baby.
- “Finish” one
side before offering the other (see protocol
for increasing breastmilk intake by the
baby for an explanation on how to know
the baby is getting milk)
- Do not limit the baby
to one side if the baby is not getting
enough.
- Switch to the other
side once the baby is no longer getting
milk even with the compression.
- Switch back and forth,
as long as the baby is getting good amounts
of milk.
- See the Protocol
for increasing breastmilk intake by the
baby.
See
the handout Protocol
for increasing breastmilk intake by the
baby, and handout #25, Slow
Weight Gain After the First Few Months.
See also the videos
on how to latch a baby on, how to know the
baby is getting milk, how to use compression,
how to use a lactation aid, as well as other
information sheets
on breastfeeding.
Questions? (416) 813-5757
(option 3) or drjacknewman@sympatico.ca
or my book Dr. Jack Newman’s Guide
to Breastfeeding (called The Ultimate Breastfeeding
Book of Answers in the USA)
Handout #19b. Domperidone-2.
January 2005
Written by Jack Newman, MD, FRCPC. ©
2005
This handout may be copied
and distributed without further permission,
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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