Domperidone (Motilium®)

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Domperidone promotes the release of prolactin from the pituitary gland. It is a dopamine antagonist with anti-emetic properties.

Midwives can prescribe domperidone in the postpartum period only for the treatment of insufficient milk supply (I.M.S.). However, this treatment should not be used as the first approach to correcting IMS. A comprehensive assessment and attention to other factors that can influence milk supply and milk transfer should be completely explored as a priority prior to prescribing domperidone

Regardless of treatment plan, failure of the newborn to regain birth weight by three weeks of age is an indication for a consultation with a physician (CMBC, 2015).

Amongst lactation specialists in Canada and based on individual clinical evaluations, Domperidone has historically been prescribed in doses ranging from 30-90 mg/day to a maximum dose of 80-160 mg/day.

Amongst lactation specialists in Canada and based on individual clinical evaluations, Domperidone has historically been prescribed in doses ranging from 30-90 mg/day to a maximum dose of 80-160 mg/day. However, there have been numerous warnings by Health Canada regarding the risk of serious abnormal heart rhythms or cardiac arrest with the use of domperidone. Clients at greatest risk of this adverse effect include those:

  • Taking more than 30 mg/day;
  • With a history of cardiac disease or abnormal heart rhythm;
  • Taking other medications that prolong QTc;
  • With abnormal electrolytes (e.g. changes in potassium from diarrhea or vomiting);
  • Who are more than 60 years of age.

Indications and Clinical Use:

Used to enhance breastmilk production where non-pharmacologic methods have proven ineffective and there is inadequate milk supply.

Contraindications:

Hypersensitivity to domperidone or its excipients, with gastrointestinal obstruction, perforation, or hemorrhage, with prolactinoma, and for those with a history of breast cancer.

Warnings and Precautions:

Due to the increased risk of QTc prolongation, domperidone should not be administered with other medications that may also prolong QTc (including but not limited to fluconazole, macrolide antibiotics [azithromycin, erythromycin], SSRIs, methadone). Check the client’s current medications to assess for drug interactions with domperidone.

Pregnancy:

Category C

Lactation:

Category L1 – Limited Data – Compatible

Adverse Reactions:

Headache (1% – resolved with dose reduction), dry mouth (2%), abdominal cramps (less than 1%), rashes and urticaria and alteration of menstrual cycles.

Dosage and Administration:

Usual dose – Domperidone: 10 mg PO every 8 hours (tid) x 7-14 days

Onset of Action:

Time to peak serum concentration: 30 minutes

Half-life:

7 hours

Therapeutic Notes:

Milk supply is usually increased within three to four days, although effects may be seen as soon as 24 hours. Domperidone dosage should be gradually reduced by one tablet every 2-3 days when milk supply is adequate