Using Domperidone to increase milk supply
Domperidone is a prescription-only medication that can be used to help breastfeeding parents increase their breast milk supply.
According to Australia’s dietary guidelines, infants should be breastfed exclusively, if possible, for the first six months of their lives, starting solid foods at about six months of age. If it suits both mother and child, it is recommended that breastfeeding be continued until at least the child’s first birthday, if not beyond.
Of course, breastfeeding, if you choose to do it, can be a wonderful way to nourish your baby, but it can also be rife with challenges that can not only make the process more difficult but also be quite distressing for mothers who have their hearts set on nursing their little ones.
Some of these challenges include insufficient milk supply, latching issues and more. For the purpose of this article, we’ll focus on low breast milk supply and how domperidone as a galactagogue (a substance used to increase breast milk) may be able to boost breast milk supply.
Understanding domperidone
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What is domperidone?
Domperidone is a dopamine antagonist medication used to treat nausea and vomiting as well as certain gastrointestinal issues such as gastroparesis. In some cases, it has also been found effective in controlling breast milk production.
How does domperidone work to increase milk supply?
Domperidone’s ability to enhance lactation is thought to be related to its dopamine receptor-blocking properties. When domperidone is used “off label” it can boost milk supply in breastfeeding mothers by blocking dopamine receptors, which leads to an increase in prolactin (a key hormone involved in human milk production) levels. Elevated prolactin levels, in turn, stimulate the mammary glands in the breast to produce more milk.
Safety and TGA (Therapeutic Goods Administration) status of domperidone for breastfeeding support
In Australia, it is considered safe to use domperidone as a galactagogue, but its use is subject to certain restrictions and caution.
The Therapeutic Goods Administration (TGA) in Australia provides guidelines on the use of domperidone for lactation, including recommended dosages and precautions. In many cases, its use is limited to situations where other measures to stimulate milk supply – such as seeking support from a lactation consultant- have not been successful, and its prescription is often accompanied by close monitoring for potential side effects.
Your doctor will also take your medical history into account before moving forward with domperidone.
When to consider domperidone
If you’ve tried other methods of increasing your breast milk supply such as frequent expressing, consulting with a lactation consultant and natural foods (such as fenugreek, for example) you might want to consider using domperidone as a galactagogue.
Your regular doctor will be the one to decide if domperidone is the right choice for you, based on your medical history (including personal or family history of cardiac arrhythmias or abnormal heart rhythms), the use of medicines that affect the rhythm of the heart (QT-prolonging medications), and any medicines that may increase the side effects or action of domperidone.
There are several situations in which a mother might need or want to increase her milk supply. It’s important to note that each breastfeeding experience is unique, and the need for increasing milk supply can vary among individuals.
Some of the reasons a parent may want to increase breast milk supply include:
- Baby’s growth spurt: Babies typically go through growth spurts during which they may demand more milk. This increased demand can signal the body to produce more milk to meet the baby’s needs.
- Low weight gain in the baby: If a baby is not gaining weight as expected, healthcare providers may recommend increasing breast milk output to ensure the baby receives sufficient nutrition.
- Premature birth or low birth weight: Preterm infants or those with low birth weight may need more milk to support their growth and development.
- Returning to work: Mothers who are returning to work and plan to continue breastfeeding may need to increase their milk supply to build a stash for times when they are away from the baby.
- Illness or hospitalisation: If the mother or baby is ill or hospitalised, maintaining or increasing supply can be crucial for providing the necessary nutrients and antibodies.
- Exclusive pumping: Mothers who exclusively pump may need to work on increasing their milk supply, as the pumping process can sometimes be less effective than direct breastfeeding in stimulating milk production.
- Breastfeeding challenges: Certain breastfeeding challenges, such as latch issues, tongue-tie, or other difficulties, can result in low breast milk supply.
Getting a prescription for domperidone
As mentioned earlier in this article, domperidone is a prescription-only medication, and one which needs to be prescribed by your regular doctor.
If you have explored other avenues of breastfeeding support and they haven’t been successful, you can talk to your doctor about the potential benefits of using domperidone to boost breast milk supply.
Typically, your doctor will prescribe the lowest possible dose of domperidone, to begin with, and then increase the dosage if needed, depending on how you and your baby are responding.
Like with all prescription medications, it is important to only ever take medicine that has been prescribed specifically for you. You should never try someone else’s medication, even if they say it has worked well for them.
Dosage and administration
In Australia, the usual starting dose of domperidone is 10 mg (one tablet) every eight hours, or three times a day until breast milk supply is well established. This may take several weeks.
Occasionally, your lactation consultant or doctor may increase the dose to 20mg (two tablets) three times a day. The dose may vary depending on your milk supply, but you should not have more than 60mg (six tablets) in one day.
Once your breast milk supply is well established, you can start to decrease the dosage for one week, before stopping the medicine altogether. Your GP will guide you on this process once they are satisfied you have adequate breast milk supply.
Domperidone as a galactagogue works best if you are also regularly expressing breast milk using an electric breast pump.
How is domperidone taken?
Typically, the tablets are swallowed with water or dispersed in a small amount of water.
What should I do if I forget to take a dose?
Never give a double dose of medication to make up for a missed dose.
Take the missed dose if you remember during the day, as long as it is at least four hours before the next dose is due. Otherwise, skip the missed dose and continue to administer the medication as usual. If you miss several doses in a row, consult your doctor.
I took my dose, but then vomited – now what?
If you become vomit within 30 minutes of taking domperidone, take the same dose again.
You do not need to take another dose of domperidone if you become vomit more than 30 minutes after taking it. Wait until the next scheduled dose.
If you continue to vomit, consult your lactation consultant or GP, as this may have an impact on your breastfeeding. They will make a decision based on your condition and your baby.
How to know if domperidone is working
It may take up to a week to notice an increase in breast milk supply once you start taking domperidone, and up to two to four weeks to see the full effect. Continue to breastfeed or express during this time and contact your breastfeeding specialist, such as a lactation consultant, doctor, or maternal and child health nurse if you have any concerns or feel you need additional advice.
There are a few steps you can take to monitor your progress and track whether taking domperidone is increasing your breast milk output.
- Keep a milk supply log: Record the amount of milk you pump or express before and after starting domperidone. Jot down the frequency of breastfeeding sessions and any changes in milk production.
- Weigh your baby regularly: Regularly weigh your baby to track their growth. An increase in weight can be an indication that they are getting enough milk.
- Track wet nappies: Monitor your baby’s nappy output. An increase in wet diapers and bowel movements may suggest improved milk intake.
- Monitor your baby’s behaviour: Pay attention to your baby’s behaviour during and after breastfeeding. If they seem more satisfied and content, it could be a sign that they are getting more milk.
Combining domperidone with other strategies or medications
While the use of domperidone can help to boost breast milk supply, increasing maternal milk production can also be influenced by other lifestyle factors and strategies. For one, it’s really important that breastfeeding mothers stay hydrated (it’s thirsty work, after all!) and nourished as dehydration and poor nutrition can impact breast milk supply.
As you likely already know, breast milk production is based on supply and demand, so the more you are nursing or expressing, the more your body should produce to meet the needs of your baby. Try to ensure you are feeding on demand and pumping regularly in order to stimulate milk production and establish a good supply.
Another factor that can impact milk production is how your baby latches. If an infant does not latch properly, they will not drain the breast fully, meaning your body will not get the message to produce more breast milk. The art of latching can be tricky to master, so always reach out to your doctor or lactation consultant if you are having difficulty.
Skin-to-skin contact can be another way to boost breast milk supply, in addition to taking domperidone. This is because having skin-to-skin contact with your baby increases the release of hormones, such as oxytocin, which can boost milk supply.
You may also want to consider other natural galactagogues as part of your diet – although you should always talk to your doctor before combining herbal medicines with the use of domperidone. Foods such as oats, fennel and fenugreek are all believed to help milk production, as are leafy greens such as kale and spinach and legumes or beans such as lentils and chickpeas. There are some studies that suggest that milk thistle can also stimulate supply, but again, it’s important to talk to your doctor before taking herbal medicines.
In addition to domperidone doses, you can also try gentle breast massage and compression – either with your hand or a tool such as the Lactamo Breastfeeding Ball – to boost breast milk supply and avoid issues such as mastitis.
Working with a lactation consultant or midwife for breastfeeding support can also be really beneficial if you are struggling with milk production as they can address issues such as latching and offer personalised guidance on how to overcome them.
Safety and potential side effects
A very small amount of domperidone can pass into your breast milk, but there have been no reports of harmful side effects in the baby from women taking domperidone.
Like with all medications, some women taking domperidone will report side effects. These can include dizziness, fainting or heart palpitations, dry mouth, restlessness, muscle spasms, headache or abdominal pain. Always talk to your doctor if you experience any severe side effects or if you have any concerns.
Domperidone should not be combined with certain medications that affect the heart or are broken down by the body via a specific pathway, increasing the risk of domperidone causing heart problems. The doctor will review your medication list to ensure that you are not taking any of these medications before prescribing domperidone to increase milk production.
Weaning off domperidone
Weaning off Domperidone should be done under the guidance of your healthcare provider, especially if you’ve been using it to boost milk supply. Abruptly stopping the medication can lead to a sudden decrease in breast milk volume.
Before making any changes to your medication, consult your healthcare provider. They can provide guidance on how to gradually reduce domperidone treatment and monitor your breast milk output during the process.
It’s typically recommended to gradually reduce the dosage rather than stopping abruptly. Your healthcare provider may suggest decreasing the dose by half for a certain period before further reductions.
For example, your doctor may recommend that once you’ve established an adequate breast milk supply you continue taking one tablet (10mg) every eight hours (three times per day) for another week; then, gradually reduce the medicine over a few days and then stop. Women taking domperidone for breast milk supply issues should work closely with their prescribing doctor to ensure their plan for weaning is best suited to their particular situation.
Be sure to keep a close eye on your milk supply during the weaning process. If you notice a significant drop in milk production, talk to your doctor to adjust the weaning plan.
Keep an eye out for signs of engorgement or mastitis during the weaning process. If you experience any discomfort or notice redness, warmth, or swelling in your breasts, contact your doctor.
Continuing to take domperidone as a galactagogue long-term has no benefit once the initial increase in milk occurs, so once you and your doctor are satisfied with your breast milk volume, be guided by your GP as to how to start tapering off.
Domperidone versus metoclopramide
When it comes to breastfeeding and breast milk supply issues, domperidone is often preferred over metoclopramide.
Metoclopramide has been used in the past to boost milk supply, but it is not the first choice due to potential side effects. Its use for lactation is limited because it can cross the blood-brain barrier, leading to neurological side effects such as restlessness, drowsiness, and, in rare cases, more serious movement disorders.
The decision between domperidone versus metoclopramide should be made in consultation with a healthcare provider. They will consider your medical history, potential side effects, and individual factors to determine the most appropriate medication for your situation.
What should I do if my supply remains low?
If your supply remains low, even after being prescribed domperidone or using herbal medicines such as milk thistle, there may be other factors that you need to identify before you can potential improve breast milk supply.
For example, you may want to review stress levels, nutrition, other medications, hydration, and overall health as these can all contribute to insufficient lactation. Your healthcare provider may also want conduct additional tests to rule out any underlying issues affecting milk supply, such as hormonal imbalances or medical conditions. They may also consider adjusting the dosage of domperidone based on your response and any observed changes in milk volume. Be guided by them on whether to continue with the current dosage, increase it, or gradually decrease it if appropriate.
Another option you might consider is pumping milk by way of power pumping. Power pumping involves using a breast pump for short, intense pumping sessions followed by rest periods and can mimic cluster feeding, potentially increasing milk production. For example, you might pump for 20 minutes, rest for 10, pump for 10, rest for 10, and pump for 10 again. This method of increasing milk volume is obviously quite time consuming, but can be a good option for parents who have their hearts set on exclusive breastfeeding.
Breastfeeding support groups and lactation consultants can also be useful resources for women looking to increase breast milk volume and have had limited luck with herbal medicines or other medications.
Unfortunately, sometimes breastfeeding just doesn’t go to plan and despite a mother’s best efforts to stimulate supply, they still find they have insufficient milk to feed their little one. Low supply and other breastfeeding challenges can be extremely distressing for parents, especially if it means their breastfeeding journey has to end prematurely.
If this is the situation you find yourself in, be sure to seek advice and support from a counsellor or someone you feel comfortable talking to. Remember to be kind to yourself and try not to let your experience with breastfeeding define how you see yourself as a parent. Low supply is sometimes sometimes something that cannot be helped, so you should talk to your doctor or child’s pediatrician about a suitable alternative such as formula or donated breast milk.
What causes low milk supply?
Low milk supply can be caused by several different factors or a combination of factors. According to the Royal Australian College of General Practitioners (RACGP), “having ‘low supply’ of milk is a common concern for breastfeeding mums, but in many cases this may be a case of what they think is a low supply, rather than a real issue of low supply.” That is why it’s important to talk to your doctor or lactation consultant before starting a course of action to try controlling breast milk production.
Possible reasons for a woman not having adequate milk production will vary from person to person but could include:
- Inadequate breast stimulation: The demand for breast milk is closely linked to breast stimulation. If breastfeeding or pumping sessions are infrequent or ineffective, it can signal the body to produce less milk.
- Poor latch or breastfeeding technique: An improper latch or ineffective breastfeeding technique can hinder the baby’s ability to extract milk efficiently. This can lead to decreased milk production over time.
- Supplementing with formula: Introducing formula supplements can impact supply because it reduces the baby’s demand for breast milk. The breast works on a supply-and-demand basis, and supplementing can signal the body to produce less milk.
- Scheduled feeding and lack of night feeds: Strict feeding schedules or skipping night feeds may reduce the frequency of breastfeeding, resulting in lower milk supply. Nighttime feeds are particularly important for stimulating milk production.
- Maternal stress and anxiety: High levels of stress and anxiety can affect hormone levels, including prolactin, which is essential for production. of milk Finding ways to manage stress is crucial for maintaining a healthy supply.
- Medical conditions: Certain medical conditions, such as polycystic ovary syndrome (PCOS), thyroid disorders, diabetes, or hormonal imbalances, can impact the production of breast milk. Addressing these underlying conditions may help improve supply.
- Breast surgery or trauma: Previous breast surgeries or trauma to the breasts can affect the milk ducts and glands, potentially leading to reduced supply.
- Hormonal birth control: Some hormonal contraceptives, especially those containing estrogen, can interfere with the supply of breast milk. Non-hormonal birth control methods are often recommended for nursing mothers.
- Insufficient glandular tissue: Some women may have insufficient glandular tissue (IGT), a condition where the breast tissue is not fully developed. This can limit the amount of milk the breasts can produce.
- Retained placental fragments: In rare cases, retained placental fragments after childbirth can interfere with hormonal regulation and milk output.
- Dehydration and poor nutrition: Inadequate hydration and poor nutrition can impact your supply. If you are breastfeeding, it’s really important to maintain a well-balanced diet and stay adequately hydrated.
- Certain medications: Some medications can interfere with the body’s ability to produce breast milk. It’s super important to consult with a healthcare provider before taking any medication while breastfeeding.
Remember that each woman’s experience nursing is different, and that what works for one may not work for another. If you are worried that you are not producing enough milk for your little one, talk to your healthcare provider so they can first establish whether there is, in fact, an issue with supply and then develop a personalised plan to address the issue and potentially begin increasing breast milk production.
Frequently asked questions
Who should take domperidone?
Only a doctor can decide if domperidone containing medicines are the right course of action for people looking to increase breast milk volume. Your regular GP can work with you to decide if it might be a good fit based on your needs, medical history, other medications and what other strategies you have tried for increase milk production.
What are reasons someone may take domperidone?
The reasons for taking domperidone for low breast milk supply vary but could be due to illness in the mother, to prepare for pumping as she returns to work or simply because the mother is not ready to give up on the idea of breastfeeding their little one.
How can domperidone help preterm infants?
Domperidone has been used off-label in some cases to support lactation in mothers of preterm infants. By increasing prolactin levels, it may help mothers establish and maintain a milk supply, which is crucial for feeding preterm infants. Improved feeding tolerance and increased milk intake can contribute to better weight gain in preterm infants. Adequate weight gain is a crucial factor in their overall growth and development.
How do I know if domperidone is safe for me?
Only your doctor can determine whether any medication is safe for a particular patient. There are a few reasons why your GP may avoid prescribing domperidone, such as if you are taking other medications that affect the rhythms of the heart.
Is domperidone better than herbal medicines?
Again, this is something that is different for each person. Some women may find herbal medicines effective and feel more comfortable taking natural measures than a prescription medicine. Others may have had limited success with herbal medicines and therefore want to try something else. As always, it’s important to go over your options with your doctor so you can decide the best path forward together.
What are the side effects of domperidone?
Some of the side effects that have been reported in people taking domperidone include dry mouth, abdominal pain, headache, restlessness, muscle spasms and heart palpitations. See your doctor if you have any concerning side effects.
Can I take domperidone while pregnant?
Domperidone is generally not recommended during pregnancy unless the potential benefits outweigh the risks. Consult with your doctor before using it during pregnancy.
Can I use domperidone without a prescription?
Domperidone is a prescription only medication in Australia and you should never take medication that has been prescribed for someone else.
How long does it take for domperidone to work for increasing milk supply?
The time it takes for domperidone to increase milk supply can vary among individuals. Some mothers may notice an improvement within a few days, while for others, it may take a couple of weeks.
How does domperidone work to increase milk supply?
Domperidone works by blocking dopamine receptors, which leads to an increase in prolactin levels. Prolactin is a key hormone involved in stimulating milk production.
The takeaway
Breastfeeding is a deeply personal experience and one that often comes with unexpected challenges. Domperidone is one option to consider for increasing breast milk volume, but it’s not a one-size-fits-all solution and should only be used under the guidance of your healthcare provider, who will consider your health, how your body responds, and potential side effects.
Medication can seem like just one more thing to think about for parents who already have a lot on their plates, from changing nappies to dealing with sleepless nights. A support network can be extremely helpful during these times, so seek support and encouragement from family, friends, and partners. Every little victory is something to be proud of because parenting is a team effort!
If low milk supply is something you’re dealing with, remember you are not alone – breastfeeding difficulties are a common complaint for parents and there is always plenty of support available should you need it.
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