Everything to Know About Domperidone, the Controversial Drug That Could Promote Breast Milk Production

Recent news that doctors prescribed a medication that (along with a hormone regimen) helped a trans woman breastfeed her baby has grabbed headlines. It’s also brought up questions about whether this drug could help other moms who struggle to nurse. Turns out domperidone (or Motilium) has been used for this purpose for years—though, because it’s not FDA-approved, not always openly. Here’s the lowdown about discussing with your doctor.

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How does it work? The intended medical purpose of domperidone is to aid digestion and curb nausea in patients with GI disorders like acid reflux. However, a proven side effect is that it stimulates the pituitary gland to produce Prolactin, the hormone that causes breastmilk production. In the UK and Canada, it is widely prescribed to help nursing mothers, though—experts caution—usually as a last resort, after all other attempted supports (latch correction, increased pumping frequency, skin to skin contact) have failed. Writes Dr. Jack Newman, one of Canada’s leading breastfeeding experts: “There are several studies that show that it works to increase milk production and that it is safe.”

Is it safe for the baby? Advocates say yes. If prescribed in the correct dosage and administered by an MD, “Domperidone has [few] side effects because it does not enter the brain tissue in significant amounts (does not pass the blood-brain barrier),” writes Dr. Newman. “The amount that gets into the milk is so tiny that side effects in the baby should not be expected. Mothers have not reported any to us, in many years of use.” Writes Dr. Mona Gabbay, an MD who has dedicated her decades-old practice to helping mothers breastfeed: “It is minimally excreted in the milk, so the baby will not be affected by it. It is on the American Academy of Pediatrics' list of drugs thought to be safe for nursing mothers.”


Why is it not FDA-approved? “In June 2004, the Federal Drug Administration (FDA) in the U.S. put out a warning against using domperidone because of possible cardiac side effects,” writes Dr. Newman. “This unfortunate step was taken without considering the fact that the cardiac side effects occurred only when the drug was taken intravenously by otherwise very sick patients.” [Emphasis ours] The FDA warning, writes Gabbay “basically said that they never studied the drug and that by taking it, nursing mothers may be putting themselves and their babies at risk. They had no new data about the drug.” That said, if you are at risk for heart disease or arrhythmia, it is especially important that you speak with your doctor before considering this medication.

How could one get it? Some moms—under the guidance of their doctors—order it from non-U.S. pharmacies (like in New Zealand or Canada) and receive it in the mail. Writes Dr. Newman: “The Federal Drug Administration has no authority outside the U.S,, and even in the U.S., compounding pharmacies, which are not regulated by the FDA, are continuing to provide patients with domperidone.” However, the FDA has been cracking down on American compounding pharmacies making and selling the drug.

Are there any side effects? There is no such thing as a 100% safe drug,” writes Dr. Newman. “However, our clinical experience has been that side effects in the mother are extremely uncommon, except for increasing milk supply.”


Know anyone who’s used it? We know two. Neither mom reported any negative side effects. One struggled to breastfeed her son for five months and, after he lost too much weight due to her low milk supply, was advised by a lactationist that he have a frenotomy to open up his mouth wider and aid nursing. She decided against it after several pediatricians confirmed he was not tongue-tied and the surgical procedure was unnecessary. Under the care of her doctor, she started domperidone and was able to increase her milk supply to four pumped ounces a day for about another six weeks (she supplemented with formula). When she weaned herself off the drug, she also stopped nursing. “Domperidone is not a miracle drug,” writes Gabbay. “It works slowly to increase milk production.” But for some moms, that may be more than enough.

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