Domperidone and the FDA
Low breast milk supply can cause stress in new families, but if natural methods are not working to increase milk production, domperidone can help new mothers to continue breastfeeding their babies.
New mothers who have low supplies of breast milk, and who have tried natural means of increasing supply, may be looking to prescription medication for help. The FDA has issued warnings about one of the most effective drugs, domperidone (Motillium), making it difficult for anyone in the United States to gain access to it. However, many advocates of breastfeeding feel that the warnings are unfounded and that they only discourage breastfeeding.
How Domperidone works
Domperidone is a drug that is generally used for gastrointestinal disorders such as gastroparesis. However, one of its side effects is that it increases prolactin, the hormone that stimulates milk production. The drug does this by interfering with dopamine levels; one of dopamine’s functions is to decrease prolactin secretion, so lowering dopamine levels increases prolactin secretion.
The FDA’s stanceDomperidone is available in Canadian pharmacies, but it has not been approved by the FDA for any use in the United States, and the FDA has issued specific warnings against its use for lactation stimulation. It has also issued an Import Alert, and border personnel will refuse entry to any packages containing domperidone.
A drug that was commonly used to increase breast milk supply before domperidone was metoclopramide. Many women using this drug experienced severe side effects, including extreme depression, a side effect that is too risky for new mothers who are already susceptible to post-partum depression; irritability; and fatigue.
The manufacturer of domperidone has not approved it for use for stimulation of breast milk production, but there are studies that suggest that it is effective and safe for this use.
The side effects of domperidone are uncommon, and tend to be less severe than those of metoclopramide. They include abdominal cramping, dry mouth and headaches. Much of the FDA’s concern comes from reports of cardiac arrest in patients who received domperidone intravenously. Intravenous use is not prescribed for breastfeeding mothers.
Domperidone is not intended for long term use, and there have been reports of increased tumour growth in rodents given domperidone over a long period of time. However, it is important to note that many of these studies were based on high doses, over a longer period of time than most women would use it for. As well, studies have shown that breastfeeding decreases the risk of tumour growth, and the longer the baby is able to breastfeed the greater the decrease in risk.
While it is important to heed the warnings on medications, it is also important to weigh the cost of not using the medication. For women who have tried every other method to increase milk supply, domperidone may be the only option for continuing to breastfeed their babies. Like any other drug, it is not without risks, but many of the serious and highly publicized risks (such as cardiac arrest) are not associated with the low-dosage and short-term use that most women would need.
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