Introduction:
Domperidone (Motilium™) is a drug that has, as a side effect, the increase of milk production, probably by increasing prolactin production by the pituitary gland. Prolactin is the hormone that stimulates the cells in the mother's breast to produce milk. Domperidone increases prolactin secretion indirectly, by interfering with the action of dopamine, whose action is to decrease the secretion of prolactin by the pituitary gland. Domperidone is generally used for disorders of the gastrointestinal tract (gut) and has not been released in Canada for use as a stimulant for milk production. This does not mean that it cannot be prescribed for this reason, but rather that the manufacturer does not back its use for increasing milk production. However, there are several studies that show that it works to increase milk production and that it is safe.

When is it appropriate to use domperidone?:
Domperidone must never be used as the first approach to correcting breastfeeding difficulties. Domperidone is not a cure for all things. It must not be used unless all other factors that may result in insufficient milk supply have been dealt with first.

1. Do as much skin to skin as possible with the baby, during and in between feedings.

2. Correct the baby's latch so that the baby can best obtain the milk the mother has available. Correcting the latch may be all that is necessary to change a situation of "not enough milk" to one of "plenty of milk" (See the video clips on our website www.drjacknewman.com).

3. Use breast compressions to increase the intake of milk.

4. If you are breastfeeding exclusively, try expressing your milk after the feedings. A few minutes of hand expression after the feedings may be very effective to increase the milk supply. Some mothers may wish to use a hospital grade pump for 10-15 minutes after feedings—this may be very effective for some and not at all for others. Do what you can. A mother exhausted from pumping is probably no further ahead with milk production.

4. Correct sucking problems, stopping the use of artificial nipples and other stratagems.

Using Domperidone for Increasing Milk Production:
Domperidone works particularly well to increase milk production under the following circumstances:

· It has frequently been noted that a mother who is pumping milk for a sick or premature baby in hospital has a decrease in the amount she pumps around four or five weeks after the baby is born. The reasons for this decrease are likely many (not putting the baby to the breast early enough, no true kangaroo mother care, etc), but domperidone generally brings the amount of milk pumped back to where it was or even to higher levels.

· When a mother has a decrease in milk supply, often associated with the use of birth control pills. Avoid estrogen containing, or even progesterone only birth control pills or progesterone releasing intrauterine devices (Mirena) while breastfeeding. See the handout, Slow Weight Gain Following Early Good Weight Gain for other reasons milk supply might decrease and fix what can be fixed.

Domperidone still works, but often less dramatically when:

· The mother is pumping for a sick or premature baby but has not managed to develop a full milk supply.

· The mother is trying to develop a full milk supply while breastfeeding an adopted baby.

· The mother is trying to wean the baby from supplements.

Side Effects of Domperidone:
· As with all medications, side effects are possible, and many have been reported with domperidone (textbooks often list any side effect ever reported, but symptoms reported are not necessarily due to the drug a person is taking). There is no such thing as a 100% safe drug. However, our clinical experience has been that side effects in the mother are extremely uncommon, except for increasing milk supply. Some side effects which mothers we have treated have reported (very uncommonly, incidentally):headache which disappeared after a few days or when the dose was reduced (probably the most common side effect)

· abdominal cramps

· dry mouth

· alteration of menstrual periods

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. Certainly the amount the baby gets through the milk is a tiny percentage of what babies would get if being treated for spitting up. Remember, this is a medication often given to babies for reflux.