MIDIRS Digest Hot Topic: Is there a future for domperidone to help breast milk supply? A review of the evidence
By Student Midwife, University of Plymouth, Fiona Howard on 13 September 2021
The World Health Organization (WHO) recommends babies should be breastfed or receive breastmilk exclusively for the first six months and in addition to a varied diet for up to two years and beyond (WHO 2021). In the United Kingdom (UK) evidence shows under half of mothers are using breast milk at 6–8 weeks postpartum and only one per cent of babies are receiving breastmilk at 12 months old (Public Health England 2020).
As a breastfeeding peer supporter I often support women who are struggling with a perceived low milk supply and have considered whether the use of a drug that has a known non-intended side effect of increasing breastmilk supply — domperidone — should be explored.
In this paper I review the risks of domperidone against the benefits of continued breastfeeding by investigating the pharmacology, ethical and legal considerations, the role of the midwife, and the literature surrounding domperidone.
What is domperidone?
Domperidone was first synthesised by a Belgian company, Janssen Pharmaceutica, in the early 1970s. Antipsychotic medicines were discovered to affect dopamine receptors and frequency of vomiting (Sneader 2005). However, patients also developed undesirable neurological side effects, known as extrapyramidal effects. To alleviate these side effects, and act as a reliable anti-emetic, Janssen Pharmaceutica attempted to develop a dopamine antagonist that failed to cross the blood-brain barrier.
Domperidone was known and marketed as ‘Motilium’ in West Germany and Switzerland from 1979 and from 1982 in the UK. In 1999, domperidone was produced as an orally dissolving tablet. Domperidone can also be administered intravenously or intramuscularly (IM) due to a common side effect of xerostomia (‘dry mouth’), which may affect oral administration (National Health Service (NHS) 2020a).
Historically domperidone was prescribed as an anti-emetic in children. However, in a randomised controlled trial (RCT) of 292 participants, Leitz et al (2019) found no significant difference between the intervention and the placebo in paediatric patients and, due to the side effects of domperidone, suggested alternative medicines would be a preferred option. Consequently, the Medicines and Healthcare products Regulatory Agency (MHRA) recommended that domperidone’s licence be removed for use in children under 12 years of age or weighing less than 35kg due to insufficient research (MHRA 2019).
Domperidone as a galactagogue
Side effects are secondary symptoms caused by medicines, differing from adverse reactions. At times, the side effects are the rationale behind the prescription. All medicines have the potential to cause side effects, including General Sales Licence (GSL) medicines, herbal remedies, and supplements (NHS 2018) and should be supplied with a patient information leaflet (PIL) outlining side effects and the likelihood of developing them.
Side effects of domperidone include a dry mouth, anxiety, asthenia, breast abnormalities, gastrointestinal (GI) complications, lactation disorders and cardiac complaints (Joint Formulary Committee 2020).
Domperidone as a galactagogue is interesting as it is prescribed and administered based on a side effect, rather than its primary use.
Howard F. MIDIRS Midwifery Digest, vol 31, no 3, September 2021, pp 278-283
Original article © MIDIRS 2021