Domperidone is used short-term in breastfeeding mothers of children being treated at the Queensland Children’s Hospital (QCH) with the aim of improving breast milk supply.

While using this medicine – Remember

Domperidone is not recommended for use in mothers with cardiac arrhythmias or mothers taking any medication which may cause cardiac arrhythmias.
Domperidone in very small amounts enters the breast milk but there have been no known cases of harmful cardiac effects on babies. The Cardiac Team at QCH have reviewed the available information about domperidone in breast milk and are happy to continue to use domperidone in otherwise well-breastfeeding mothers of babies being treated at QCH.
If you are taking any other medication, including over the counter or complementary medicines (also known as traditional or alternative medicines including vitamins, minerals, herbs, aromatherapy and homeopathic products) from a health food store, discuss this with your doctor prior to commencing domperidone.

Domperidone is available as

Tablets: 10mg
The brand of product supplied to you is: Motilium ® 10mg Tablets

It is available on prescription from the hospital or community pharmacy.

How does domperidone work to improve breast milk supply?

Breastfeeding is recommended as the optimal form of nutrition for term and preterm infants. There are many health advantages to breastfeeding for both you and your baby. However, mothers who wish to express milk for their hospitalised newborns are faced with numerous stressful situations. Your baby may have been born early. You may be from a rural or regional area and you or your baby; or both of you may have been transferred to Brisbane for specialised care. It may also be some time until your baby can begin breastfeeding. All of these things can affect how well your body produces breast milk at this time.

Even if you are expressing frequently, your milk supply may not increase, and when this happens, it might help to also take domperidone.

Sometimes medicines, taken for other purposes, have the effect on increasing breast milk as one of their side effects. They stimulate the release of prolactin, which in turn stimulates breast milk production. This is how domperidone will help with your milk supply.

Domperidone is the most effective medicine used to improve breast milk supply. It was developed to treat nausea, vomiting, indigestion and gastric reflux, but has been found to be effective when used to increase milk supply. Domperidone is currently widely used In Australia and around the world for this purpose even though it was not originally marketed for this. This is called off-label use. Your doctor will consider the following before prescribing domperidone:

Whether you have been provided adequate support from a lactation consultant, and they agree there is a persistent breast milk supply problem that may benefit from using domperidone.
Other medical conditions (particularly a significant personal or family history of cardiac arrhythmias or abnormal heart rhythms), the use of medicines that affect the rhythm of the heart (QT-prolonging medications), and any medicines that may increase the side effects or action of domperidone.
The risks and benefits of using domperidone to increase your breast milk supply to ensure that you make an informed choice. You will be asked to sign a consent form showing that you have been given this leaflet and sufficient information about domperidone.
Using the lowest effective dose and only increasing the dose based on you, or your baby’s response. Dose increases are managed by a doctor that normally cares for you, not the hospital doctor.
How to ensure that it is working to increase milk supply, and what side-effects or adverse reactions to look for.

How do I get domperidone?

The best person to manage prescribing domperidone and monitoring therapy is a general practitioner (GP), who is able to review your history, current conditions and medicines and if domperidone is suitable for you.
Your own GP is the best option, but if you are admitted at QCH, you many need to see a GP nearer to the hospital. Find a GP Brisbane can help with this.
If you cannot make a GP appointment and be seen by the close of business the following work day, a QCH prescriber who can treat adults can start domperidone for you (if it is appropriate to do so). They can only provide a prescription for twenty-five tablets, and can only write a dose of one tablet three times a day. The hospital pharmacy can dispense 25 tablets on this prescription, which is enough for one week. You will need to organise a GP visit before these tablets run out, for the GP to take over your care.
You will need to take this information leaflet to your doctor as you will require a prescription for this medication.

When and how should I take domperidone?

Domperidone is used together with frequent expressing. It will work best for you if you are expressing regularly with an electric breast pump – this is at least eight times per day with no breaks longer than five hours.
Domperidone is normally taken by the breastfeeding mother every eight hours (three times per day). A suggested regime would be at 6am, 2pm and 10pm. Check with the lactation consultant or pharmacist on the best way to fit this medicine into your and your baby’s routine.

How much should I take?

The usual starting dose is 10 mg (one tablet) every eight hours (three times per day e.g. 6 am, 2 pm and 10 pm). The starting dose at the hospital should never exceed 30mg (3 tablets) in each 24 hours.
Once your milk supply is well established, keep taking the dose of one tablet (10mg) every eight hours (three times per day) for one more week; then it may be possible to gradually reduce the medicine slowly over a few days and then stop. It is advisable to contact the lactation consultant before you plan to stop this medication, to review your milk supply, and then talking to the doctor who prescribed it to give you a weaning plan.
The dose may change, depending on each woman’s individual response. Rarely, doses of up to 60mg (6 tablets) are used in each 24 hours, prescribed by the GP.

How should I take it?

The tablets can be swallowed with some water, or dispersed in a small amount of water (5 mL), which is then swallowed, followed by some water.
People taking domperidone for gastric conditions usually take it about half an hour before meals, but this is not necessary for use in improving breast milk supply.

When should the medicine start working and how will I know?

Most breastfeeding mothers see an improvement in milk supply usually starting after the first week.
If you are regularly expressing and taking the medication, the milk supply should improve within 3-4 weeks. If this doesn’t happen, the lactation consultant and doctor will want to review your use of the medicine.
Staying on the medicine long term has no benefit once the initial increase in milk occurs.

What to do if a dose is missed or vomited

Missed doses:

Never give a double dose of the medicine to catch up a missed dose.
For eight hourly dosing, take the missed dose when you remember during the day, as long as this is at least four hours before the next dose is due. Otherwise skip the missed dose and give the medicine at the normal times. If several doses in a row are missed, contact your doctor for advice.

Vomited doses:

If you are sick (vomit) less than 30 minutes after having a dose of domperidone, take the same dose again.
If you are sick (vomit) more than 30 minutes after having a dose of domperidone, you do not need to take another dose. Wait until the next normal dose.

If you continue to be sick (vomit), seek advice from your lactation consultant or GP, as this might affect your breastfeeding. They will decide what to do based on your condition and your baby.

What to do if I give too much domperidone

If you think you have taken too much domperidone call the Poisons Information Centre on 13 11 26 even if you show no effects. In an emergency at home, call 000 for an Ambulance or go to hospital straight away. Have the medicine packaging with you, even if it is empty, as this information will be useful. If you are admitted at QCH, let your child’s nurse know.

What about using other medicines with domperidone?

When you are breastfeeding, it is important to check all medicines that you want to take with your lactation consultant, pharmacist or doctor. This includes prescription, over the counter medicines, vitamins, supplements, herbal or complementary medicines that you buy from a pharmacy, supermarket, health food shop or online.

Some medicines might affect your milk supply or be transferred in the milk to your baby.
Domperidone should not be taken with some medicines that affect the heart or are broken down by the body by a certain pathway, which increases the risk of domperidone causing problems with the heart. The doctor will check your list of medicines to make sure you are not taking any of these medicines. Tell your doctor and pharmacist about any other medicines you are taking before starting any new medicine.

Possible side effects – what other effects can occur?

Side effects you must do something about

Dizziness, fainting or heart palpitations. Stop taking domperidone and seek medical attention
Muscle spasms
Restlessness

Other side effects you need to know about

Headache, dry mouth, abdominal pain

Possible side effects on your baby

A very small amount of the domperidone you take can pass into your breast milk, but there is no record of harmful side effects in the baby from the mother taking domperidone.

General medicine advice

Only give this medicine to the person who was prescribed it. Never give it to anyone else, even if their condition appears to be the same, as this could do harm. Contact Poisons Information Centre on 13 11 26 if another person takes this medicine.
Always have enough supply of Domperidone. Your GP will provide all repeat prescriptions, as the hospital can only supply the first box.
Keep domperidone in the container it came in. At home, you may want to keep it in your medicine cupboard/storage area, out of reach of children and away from heat and direct sunlight.
If you are admitted to hospital with your baby, the nurses can store your dispensed domperidone safely, and return it to you when you need your dose. This is a safety initiative to prevent other hospitalised or visiting children being able to find the medicine in your bag, which might result in accidental poisoning.

For more information

This fact sheet is about using domperidone to improve breast milk supply and some information may be different from the manufacturer’s Consumer Medicine Information (CMI). The manufacturer’s CMI is found at NPS MedicineWise. These should be read together.

Your lactation consultant, doctor, pharmacist or nurse will be able to give you more information about Domperidone and its use in improving breast milk supply.

If you have questions about the medicine, about whether it is working, or if you notice anything unusual, please phone:

your lactation consultant
the doctor who prescribed the medication
the doctor looking after your baby.

Contact us

In an emergency, always contact 000 for immediate assistance

Pharmacy Department
Level 2, Queensland Children’s Hospital
501 Stanley Street, South Brisbane 4101
t: 07 3068 1901 (9am – 5pm Mon – Fri)
(9am – 12pm Sat – Sun/public holidays)