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Domperidone In Breastfeeding | Increase Milk Supply


Several factors can impact breast milk supply with common factors, including low breastfeeding frequency, wrong latching by a baby, late start of breastfeeding, use of formula alongside breastfeeding, and some drugs. Drug therapy to increase milk production is usually considered when insufficient milk is produced despite appropriate lactation support (Grzeskowiak et al., 2018).

Today I will review the use of Domperidone in breastfeeding. One of the uncommon side effects of Domperidone is galactorrhoea (excessive milk production), which leads to the unlicensed use of Domperidone in breastfeeding to increase the production of milk. I will review several areas considering Domperidone in breastfeeding.

What Is Domperidone?

What Is Domperidone

Domperidone is prescription-only medication (POM) licensed in the UK for the symptoms of nausea and vomiting.

Domperidone is also known as Motilium, which is a branded name of domperidone.

Both generic version and Motilium contain the same amount of the active drug – 10mg of Domperidone per tablet.

Quick FAQ

Can domperidone be used to treat acid reflux?
Domperidone is a dopamine D2-receptor antagonist that improves motility and gastric emptying in the peripheral nervous system. It is used to treat regurgitation and vomiting because it reduces postprandial reflux time.

Can You Get Domperidone Over The Counter?

Can You Get Domperidone Over The Counter

No. Domperidone is a prescription-only medication and requires a qualified prescriber, for example, a doctor to issue a prescription for the drug.

In the past, Domperidone used to be available from the pharmacy as an over-the-counter medication, sold as Motilium 10 and Motilium instants.

In 2014, Domperidone was reclassified as prescription-only medicine. Consequently, all pharmacy-only products were recalled.

The reclassification of Domperidone was a small increased risk of serious cardiac side effects (for example, QTc prolongation, torsade de points, serious ventricular arrhythmia, and sudden cardiac death) drug is taken.

Domperidone In Breastfeeding: How Domperidone Increase Milk Supply?

Domperidone is one of the most commonly used drugs when an increase in breastmilk supply is needed. As stated in the introductory paragraph, one of the uncommon side effects for domperidone use is increased milk production (galactorrhoea) alongside other uncommon side effects such as breast pain and breast tenderness. Uncommon side effects infrequently happen with estimated patients between >= 1 in 1000 and < 1/100.

Domperidone is classified as a dopamine receptor antagonist, which in plain language, it stops dopamine (a type of neurotransmitter) from working.

Dopamine, which is released in one part of the brain suppresses the release of a hormone called prolactin, which promotes lactation (milk production). Since Domperidone stops dopamine from working, more prolactin is secreted in the brain.

This stimulates milk production. During pregnancy, prolactin levels increase, causing breasts to grow (increase the size of the mammary glands) and stimulates milk production.

Domperidone In Breastfeeding: Can Domperidone Increase Milk Production?

Several studies investigated the use of Domperidone in breastfeeding. The best available evidence comes from a systemic review of those studies. The systemic review compares large data from different studies.
Grzeskowiak et al. reviewed five clinical trials on the effect of Domperidone on milk production.

Mothers included in trials expressed milk for their preterm infants (<37 weeks’ gestation). In total, 194 mothers took part in clinical trials (Grzeskowiak et al., 2018).
The main finding from this review:

  • One average mother who took Domperidone increased daily breast milk volume by 88.3ml.
  • Short-term use of Domperidone increased the amount of milk produced in mothers of preterm infants.
  • Mothers tolerated Domperidone well, with no side effects reported (no report of prolonged QTc syndrome)
  • Adverse side effects experienced by neonates were gathered in 3 out of 5 studies. Only one study confirmed adverse events in neonates. In one study, 91 infants were investigated for possible QTc syndrome at the start of the trial and 76 infants at its end. Only five infants were found to have a QTc interval >500ms. None of the infants were clinically symptomatic, and no medical intervention or treatment was required.

Cochrane produced a newer review recently to investigate the effect of milk boosters (drugs, herbal products, or foods) on milk production in breastfeeding mothers of healthy infants born at term (Foong et al., 2020).
Cochrane covered 41 studies with a total of 3005 mothers and 3006 infants.

Nine reviews compare pharmacological (drug) approaches to increase milk supply. Domperidone was one of the drugs investigated alongside other galactagogues (medicines or foods that increase milk production), including metoclopramide, sulpiride, and thyrotropin-releasing hormone.
Some findings from this large meta-analysis (review of different studies / clinical trials):

  • Overall, the evidence behind all studies was graded as low or very low.
  • Three studies compared metoclopramide, Domperidone, and sulpiride on the volume of milk produced.
  • Based on the above studies, pharmacological (drug) milk boosters such as Domperidone may increase milk volume in breastfeeding mothers (an average increase in milk production was 63ml, ranging from 26ml to 102ml). The evidence was marked as low quality with only 152 participants taking part in this study.
  • Cochrane concluded that due to the low quality of evidence, it is unknown if galactagogues have any effect on mothers who breastfed at 3,4, and 6 months.

Quick FAQ

Do you know how much domperidone raises prolactin levels?
After a week on Domperidone, the volume of pumped milk has been observed to rise by up to 44% (average age 72.5 and 79.4).

Can You Get Domperidone Prescribed On NHS?

National guideline on breastfeeding recommends several measures regarding breastfeeding problems. In the first instance, a woman with breastfeeding problems needs to be offered appropriate training by a health visitor or breastfeeding specialist, written information on infant positioning and attachment in breastfeeding, and many other recommendations.

Additionally, breastfeeding mothers may be offered details of local and national breastfeeding support groups, for example, The Association of Breastfeeding Mothers or The Breastfeeding Network.

There are plenty of educational videos on breastfeeding available on YouTube. A good attachment will help a baby get more milk and make breastfeeding more comfortable. Global Health Media Project produced an excellent video on attachment and breastfeeding. Follow this link to see it. Although intended for mothers in the developing world, this video offers some very useful tips for any mother.

Breastfeeding mothers may be examined to exclude other underlying problems, such as blocked duct, galactocele (presence of a milk cyst), or ductal infection (bacterial or fungal).

Domperidone can be considered as an off-licensed treatment to help improve milk supply, possibly after a referral to an endocrinologist is made (NICE, 2017).

It can be concluded that an NHS doctor can prescribe Domperidone in breastfeeding to increase the volume of milk produced, however, it is not the first-line recommendation.

Domperidone In Breastfeeding: Possible Side Effects

The most common side effect associated with domperidone use is dry mouth.

Some possible, uncommon side effects can be experienced when Domperidone is taken including:

Domperidone in breastfeeding: possible side effects

  • Anxiety
  • Agitation
  • Nervousness
  • Loss of interest in sex
  • Headache
  • Sleepiness/feeling dizzy
  • Diarrhoea
  • Rash / hives / itchiness
  • Painful breast
  • Milk discharge from breasts
  • Feeling weak

Although dizziness and sleepiness are uncommon side effects, patients are advised not to drive or operate machinery should they experience confusion, drowsiness, or lack of control.

Is Domperidone Excreted In Breastmilk?

Is domperidone excreted in breastmilk

Domperidone is excreted in human milk, with an estimated amount of less than 0.1% of the given dose.

The risk of possible side effects cannot be excluded in infants who are breastfed.

What Is The Dose Of Domperidone In Breastfeeding?

The use of Domperidone in breastfeeding to increase milk production is an unlicensed indication.

When used to prevent nausea and vomiting, the recommended daily dose is one tablet is taken three times a day (10mg three times a day) with a maximum of three tablets in one day (maximum 30mg daily) – this is a standard dose for Domperidone.
Mothers who took part in clinical trials discussed in this post, in most cases, were given one tablet three times a day.

  • Domperidone tablets should not be taken for longer than seven days in a row without consulting a doctor.
  • Domperidone should be taken before food (15-30 mins before a meal).

How Much Does Domperidone Cost?

Generic domperidone 10mg tablets:

  • pack of 30 tablets £0.99
  • pack of 100 tablets: £3.30

Motilium (branded domperidone 10mg tablets):

  • pack of 30 tablets: £2.71
  • pack of 100 tablets: £9.04

The above trade prices (prices: AHH Pharmaceuticals, October 2020) would only apply to patients who were prescribed Domperidone on a private prescription.

When a drug supply is made on a private prescription in a community pharmacy, customers cover the cost of medication supplied plus an additional dispensing fee (10%-20% on top of the drug cost) or a minimum charge, which varies between pharmacies.

Tesco Pharmacy is one of the cheapest pharmacies for dispensing private prescriptions. The minimum dispensing charge at Tesco Pharmacy is set at £2.00 (October 2020). Patients can expect to pay £2.00 for a supply of generic Domperidone (pack of 30 tablets). Please note that the prices of drugs change regularly.


Domperidone is one of the first choices when drug therapy is considered due to relative safety to both mothers and newborn babies (Haase 2016; Winterfeld 2012). Perhaps as Cochrane Collaboration concluded, ‘an urgent’ randomised control trial is needed to assess the effectiveness of Domperidone and other drugs in breastfeeding and impact on milk production.

Quick FAQ

Is it possible to take domperidone at night?
If necessary, domperidone should be given 15 to 30 minutes before meals and before bedtime.
  • Grzeskowiak LE, Smithers LG, Amir LH, Grivell RM. Domperidone for increasing breast milk volume in mothers expressing breast milk for their preterm infants: a systematic review and meta-analysis. BJOG. 2018 Oct;125(11):1371-1378. doi: 10.1111/1471-0528.15177. Epub 2018 Mar 27. PMID: 29469929. Available at: https://doi.org/10.1111/1471-0528.15177 Accessed on 14/10/2020
  • Foong SC, Tan ML, Foong WC, Marasco LA, Ho JJ, Ong JH. Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD011505. DOI: 10.1002/14651858.CD011505.pub2. Available at: https://doi.org/10.1002/14651858.CD011505.pub2
    Accessed on 16/10/2020
  • Haase B, Taylor SN, Mauldin J, Johnson TS, Wagner CL. Domperidone for Treatment of Low Milk Supply in Breast Pump-Dependent Mothers of Hospitalized Premature Infants: A Clinical Protocol. J Hum Lact. 2016 May;32(2):373-81. doi: 10.1177/0890334416630539. Epub 2016 Feb 23. PMID: 26905341. Available at: https://doi.org/10.1177/0890334416630539 Accessed on 16/10/2020
  • NICE (2017). Breastfeeding problems. Available at: https://cks.nice.org.uk/topics/breastfeeding-problems/ Accessed on 16/10/2020
  • Winterfeld U, Meyer Y, Panchaud A, Einarson A. Management of deficient lactation in Switzerland and Canada: a survey of midwives' current practices. Breastfeed Med. 2012 Aug;7:317-8. doi: 10.1089/bfm.2011.0092. Epub 2012 Jan 6. PMID: 22224508. Available at: https://doi.org/10.1089/bfm.2011.0092 Accessed on 16/10/2020