Domperidone

Approved as an antiemetic and prokinetic in many countries, although not in the US ^{(Hale 2018, Rowe 2013, Sachs 2013, Da Silva 2004)} and often prescribed in young infants for the treatment of gastroesophageal reflux disease. Indicated for the control of nausea and vomiting. Oral administration 3 times a day.

It is excreted in breastmilk in clinically insignificant amount ^{(Knoppert 2013, Wan 2008)}, even at doses as high as 160 mg daily ^{(Krutsch 2023)}, and no problems have been recorded in infants whose mothers were taking it. ^{(Krutsch 2023, Madjunkov 2017, Osadchy 2012, Da Silva 2001, Petraglia 1985)}

Being a dopamine antagonist, it increases the production of prolactin ^{(Wan 2008, Hofmeyr 1985, Petraglia 1985, Brouwers 1980)} and of milk ^{(Petraglia 1985)}, being able to produce galactorrhea ^{(Poovathingal 2013, Cann 1983)}, so it is widely used as a galactogogue ^{(Brodribb 2018, Rowe 2013, Grzeskowiak 2013, Anderson 2013, Winterfeld 2012, Anderson 2007, Da Silva 2004, Brown 2000)}. It does not cross the blood-brain barrier ^{(Amir 2011, Gabay 2002, Hofmeyr 1985, Petraglia 1985, Brouwers 1980)} as it has no neurological effects, so it would be preferable to metoclopramide for that purpose. ^{(Hale 2018)}

At a dose of 10 to 20 mg every 8 hours for 2 to 4 weeks, milk production increases, especially in mothers of preterm infants admitted to neonatal units ^{(Shen 2021, Khorana 2021, Wada 2019, Taylor 2019, Asztalos 2019, Grzeskowiak 2018, Brodribb 2018, Asztalos 2017, Fazilla 2017, Haase 2016, Rai 2016, Bazzano 2016, Knoppert 2013, Donovan 2012, Ingram 2012, Osadchy 2012, Campbell 2010, Wan 2008, Da Silva 2001, Petraglia 1985, Hofmeyr 1983)}, after a cesarean section (Jantarasaengaram 2012) and in cases of relactation ^{(Muresan 2011)}, lactation induction ^{(Bryant 2006)}, breast hypoplasia ^{(Duran 2011)} and transgender women. ^{(Wamboldt 2021, Reisman 2018)}

There is little evidence of its efficacy as a galactogogue in mothers of full-term non-premature infants, and beyond the neonatal period ^{(Foong 2020, McGuire 2018)}. Some studies show that it is not effective in all mothers ^{(Wan 2008)}, that it may cease to be effective by the 4th week of its administration ^{(Asztalos 2017)}, that there are no significant differences in the increase in milk production with 30 or 60 mg daily ^{(Knoppert 2013)}, and that, despite the increase in milk production, there may be neither weight gain in breastfed infants ^{(Rai 2016)} nor decreased risk of breastfeeding cessation. ^{(Grzeskowiak 2018).}

Side effects in mothers are rare: abdominal pain, diarrhea, headache, mood swings, dizziness, depression and dry mouth ^{(Suain 2022, McBride 2021, Wada 2019, Hale 2018, Ingram 2012, Jantarasaengaram 2012)} and are more frequent at high doses or prolonged treatment. ^{(Wan 2008)}. 

Domperidone has been associated with an increased risk of severe ventricular arrhythmias in older people ^{(Leelakanok 2016)} or with previous cardiac abnormalities (lengthened QT on the ECG) or associated with medications that lengthen the QT ^{(Doggrell 2014)}, being extraordinarily rare in healthy women of childbearing age ^{(Moriello 2021, Hale 2018, Madjunkov 2017, Smolina 2016)}. Only one woman with a previous history of arrhythmia presented ventricular arrhythmia among the more than 200,000 treated with domperidone in the postpartum period. ^{(Smolina 2016, Grzeskowiak 2018 & 2017)}

In order to avoid withdrawal symptoms, as insomnia, anxiety/depressión/psychosis and tachycardia ^{(Majdinasab 2022, Sharma 2021, Doyle 2018, Seeman 2015, Papastergiou 2013)}, it is advisable to carry out a slow progressive withdrawal over several weeks.

Domperidone increases the concentration of calcium in breastmilk without altering the caloric content or that of other components. ^{(Campbell 2010)}

The maternal perception of insufficient milk is one of the main reasons for cessation of breastfeeding ^{(Grzeskowiak 2019, Winterfeld 2012, Jones 2011, Zuppa 2010, Amir 2006)}. The best galactogogue is effective support and advice during pregnancy and after childbirth to achieve breastfeeding on frequent demand and with correct technique in a mother who retains her self-confidence ^{(Brodribb 2018, Anderson 2013, Mannion 2012, Forinash 2012, Comité 2012, ABM 2011, Jones 2011, Anderson 2007, Amir 2006, Seema 1999)}. Do not use as a galactogogue without health checks.

Several medical societies and expert consider the use of this medication to be safe or very probably safe during breastfeeding ^{(Shen 2021, Grzeskowiak 2018, Hale 2018, Amir 2011, Zuppa 2010, Marasco 2008, Mahadevan 2006, Lee 1993)}. American Academy of Pediatrics: medication usually compatible with breastfeeding. ^{(AAP 2001)}