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#239 Need milk? Domperidone for increasing breast milk supply

What is the efficacy and safety of domperidone to increase milk supply in breastfeeding mothers?

In mothers of pre-term infants, domperidone increases milk volume by ~90 ml more than placebo after 14 days, with an additional 1 in 5 women experiencing a 50% increase in milk supply. Doses above 30 mg/day are likely not needed and may increase the risk of arrhythmias. Optimal length of treatment unknown. 

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  • Efficacy: 
    • Newest systematic review of 5 placebo-controlled trials of 192 breastfeeding mothers of pre-term infants. All used 10mg PO TID for 5-14 days:1 
      • Mean increase in expressed breast milk volume: 88 ml/day over placebo. 
      • Maternal adverse effects: no difference. 
      • Infant adverse effects: either no difference or not reported. 
    • Largest RCT from above systematic review (90 mother-baby pairs):2 
      • Women with 50% increase in milk supply at 14 days: 78% domperidone versus 58%, Number Needed to Treat (NNT)=5.
      • Mean daily milk volume: 267 ml domperidone versus 168 ml (not statistically different, but likely underpowered). 
      • No difference in breastfeeding rates at 6 weeks. 
  • Cardiac harms: 
    • Canadian observational study of 45,518 women given domperidone in the 6 months postpartum:3 
      • Risk of hospitalizations for ventricular arrhythmia: 1.3/10,000 (domperidone) versus 0.55/10,000 (no domperidone): no statistical difference. 
        • If real, would equal a number needed to harm of 12,950. 
      •  Systematic review of 6 case control studies, mainly in men over age 60:4 
        • Arrythmia risk highest in doses >30 mg/day (OR=3.32) versus ≤30 mg/day (OR=1.63).
  • Small RCTs (7-15 women) found no difference in efficacy between 30mg/day and 60mg/day.5,6 
  • Low amounts of domperidone enter breastmilk (example <7mcg/day based on 80mg daily dose),7 but infant adverse effects similar to placebo.2,7 
  • In 2015, Health Canada warned of domperidone use and abnormal heart rhythms/sudden cardiac death. While available evidence may not apply to breastfeeding population, domperidone is contraindicated if risk of arrhythmias (examples cardiac disease/conduction abnormalities, concurrent QTc prolonging drugs or potent CYP3A4 inhibitors).8 
  • There is insufficient evidence on the use of herbal galactagogues (example fenugreek).9 

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  • Adrienne J Lindblad BSP ACPR PharmD
  • Christina Korownyk MD CCFP

1. Grzeskowiak LE, Smither LG, Amir LH, et al. BJOG. 2018; 125:1371-8.

2. Asztalos EV, Campbell-Yeo M, da Silva OP, et al. J Hum Lact. 2017; 33(1):181-7.

3. Smolina K, Mintzes B, Hanley GE, et al. Pharmacoepidemiol Drug Saf. 2016; 25(10):1210-14.

4. Leelakanok N, Holcombe A, Schweizer ML. Clin Drug Investig. 2016; 36(2):97-107.

5. Knoppert DC, Page A, Warren J, et al. J Hum Lact. 2013; 29(1):38-44.

6. Wan EW, Davey K, Page-Sharp M, et al. Br J Clin Pharmacol. 2008; 66(2):283-9.

7. Paul C, Zenut M, Dorut A, et al. J Hum Lact. 2015; 31(1):57-63.

8. Health Canada. Available at: Accessed 21-FEB-2019.

9. Bazzano AN, Hofer R, Thibeau S, et al. Ochsner J. 2016 Winter; 16(4):511–524.

Authors do not have any conflicts of interest to declare.