domperidone effectiveness

[pedal_princess]

I've been taking domperidone for nearly 4 months now. I had to double the dose (2 caps, 4x/day) in order to increase my supply. I finally noticed a slight increase when I did that. I've also been taking 6 fenugreek caps + 4 blessed thistle caps 2x/day.

I pump 1-2 extra times per day just to keep up with the bottles my baby drinks while I'm at work 3 days per week.

In the past couple weeks I've notices a big drop in my supply. I'm only pumping about 2-3 ounces total each pump session and my 9-month-old drinks 5oz!

Can domperidone lose it's effectiveness?

Is there a certain time I should be taking it? I was taking it before meals, but then switched to about 1/2 hour-20 minutes right before I pump.

[CheriK]

What's the capsule dose?  If they're the usual 10mg dose, then you're only taking 80mg per day, which is w/in the typical dose range of 30-90mg per day.  Some lactation experts believe that at least 90mg/day is needed, and some women may need up to 120mg per day (higher doses than 120mg are not recommended because there is no safety data at higher doses; doesn't mean it's unsafe for your or your nursling, just that we don't know).  Jack Newman has several handouts about domperidone: http://www.breastfeedingonline.com/Dom19abcombinedpdf.pdf.  It doesn't really matter when you take it; it's often recommended to take 30 minutes before meals, but that's because it's typically used for GI motility issues (not your concern).

Are you exclusively pumping or just pumping while at work?  Many women with excellent milk supplies struggle to produce enough with a pump. There may be changes you can make to your pumping routine to help increase your output; you may simply find that you have to pump more frequently than your baby would nurse to produce adequate milk.  Some moms will add a daily pumping session at home, often first thing in the morning when supply tends to be highest, to get that extra few ounces.  Others will pump every single day, not just when at work, to stick to a routine and help boost supply.  You can pump on one breast while baby nurses on the other; this often works well because baby stimulates a let-down, so you might find you get more milk this way.  You might also take steps to encourage your LO to nurse more while you're together, since a nursing baby is usually more effective than a pump.  Adding an extra nursing session in the morning by getting up earlier and waking your LO to nurse, spending an extra 15 minutes when you drop off at daycare, nursing immediately upon picking up your LO. . . lots of ways to do this. 

Other things to consider is if you have any pump parts failing, if you've had any other physical changes that could impact supply (such as recently starting menstruating, being pregnant again, or starting other medications that impact lactation such as birth control pills), or if your LO has started sleeping through the night.  All can impact overall supply and ability to pump milk.

Remember also that it's normal for milk supply to decrease after baby starts eating foods other than your milk.  Adding solids to the diet doesn't increase intake; solids actually displace milk.  So it's normal for you to notice gradually decreasing pump output during the second half of that first year as your supply gradually decreases and your LO gradually eats more solids.  It could be that your LO doesn't need 5oz bottles any longer, especially if you can encourage your caregiver to feed more solids while you're away you can start to replace some of that milk with other foods.  At this point, you might want to reserve solids for daycare times so solids start to displace those bottles you need to pump.  YOu can stick w/ this routine on the days when you don't work, and your body will adapt to that routine.

[pedal_princess]

1.The dom dose is 20mg per capsule. I'm taking 2 of them 4x/day.

2. I'm pumping just at work and was pumping 2x at night because we've been giving him a bottle at 9pm before putting him down at night. He doesn't sleep through night. Sometimes he feeds only once on each side and sometimes he's fussy and wants to nurse to soothe. We co-sleep after his first waking.

If I can, I pump right after he nurses too just to make sure he drained my breasts. Sometimes I'll get about 1 ounce and other times, nothing.

I don't have time to add in an extra nursing session as I already get up early to pump 1 extra time. I'm wondering if my body is getting confused because I'm pumping some days and not others. As much as I don't want to pump exclusively, I'm wondering if it'll help my body make a consistent supply?

My LO is definitely a snacker. He's 9-months and when I'm with him, he likes to nurse about every 3 hours during the day.

3. I have 2 pumps -- a Medela PIS and a hospital grade Limerick. Both are in their second life (second baby), so that could be the case. Good point and I'll check parts.

4. No other meds outside of the dom. Just supplements. My period hasn't returned and I'm not on the Pill.

5. He does a pretty good job of eating solids, but we're dealing with multiple food allergies and intolerances (still some unknown), so I'm hestitant to rely on solids as his main source for nutrition. Plus, he's been underweight since he was 5 months old and we're still trying to get back on track. He's gaining, but slowly.

[CheriK]

Replying to your points. . .

1.  Wow, I'd be a bit concerned about that dose myself.  As previously noted, there is no safety data on doses over 120mg and it's not typically recommended.  Are you working with an IBCLC?  It would be a good idea to be discussing dosage and options with a breastfeeding professional, especially with increasing dose beyond typically recommended levels.

2.  Every 3 hours sounds very normal.  Most breastfed babies are going to nurse frequently when they have the option.  I would think moving to EP'ing would be more likely to lead to an even lower supply.  Unless your LO is not removing milk well at the breast, a nursing baby is more effective than any pump.  Getting 0-1oz when pumping after nursing is a good sign that your DS is doing a good job removing milk effectively.  Can you keep up your pumping routine on at least some of the days when you don't work?  That can help boost supply and keep your body used to the pumping routine.  What about nursing instead of pumping for the bedtime feed?  Again, he's going to be more effective at removing milk than the pump.

3.  Good on checking the pumps just in case.  It's unlikely that both would be failing at the same time, though, unless you're sharing parts between them.  A pump retailer (usually an IBCLC who also sells pumps) can test the suction on them to ensure the pump motors are working well.

4.  Good!

5.  Yep, slow is better w/ solids if food allergies are a concern.  And until he's around a year (and even longer for many nursing toddlers, especially those w/ food allergies), your milk should make up the majority of his diet.  But if you are offering solids, then those will displace some amount of milk in his diet.  Having your caregiver predominately feed any solids you're including in his diet will offset the amount of milk he'll need while you're at work. 

You mention slow weight gain.  Is his gain being measured using the WHO growth charts?  The CDC charts which are still being used by most US docs are based on predominately formula-fed babies, and the growth patterns in those charts are NOT normal, especially after the first 3-4 months when breastfed babies growth is supposed to slow down.  The CDC actually recommends against using their charts, and recommends in favor of the WHO charts as representing what we now consider best feeding practices and growth expectations.

[Megan73]

ITA agree with Cheri - but I personally wouldn't be concerned with the dom dose. I've never heard of anyone being prescribed less than 90 mg/day (I'm in Canada) and women in my LLL group are taking 120 and even 160 mg a day without reporting side-effects beyond weight gain.
It's true there isn't any research into its safety (and there's unlikely to be any for a host of reasons) but the breastfeeding expert Dr. Jack Newman now prescribes up to 160 mg a day and Dr. Thomas Hale puts dom in the safest category of prescription drugs for breastfeeding moms. I've read that diabetic patients using it for digestion problems have reported taking 120 mg daily for up to 12 years without any problems.
Hale and Infantrisk are doing a major survey of women who've used dom. Let's hope some good info comes out of it.

[gemasita]

I wouldn't be concerned about the dom dosage either.  I was on 160mg a day for a while.  My doctor didn't feel comfortable trying more than that but I think going up to 160 can be quite common.

I was also going to suggest replacing the bedtime bottle with a breast-feed.

[foreverinbluejeans]

Since your baby is 9 months you could skip pumping and leaving milk. Your baby could eat solids and drink water while you are gone. Some working moms with babies as young as 6 months can do this. The baby then nurses more when mom is home and may nurse more at night. The book Working Mother, Nursing Mother discusses this in detail.

My DIL went back to work full time at 10 months, I took care of my grandson and she never pumped and he never had a bottle. He continued to nurse until he was a little over 2.5 years and she wanted to get pregnant again. She has a horrible diet and didn't want to be pregnant and nursing.

Drugs and herbs may or may not increase milk supply. I don't think they are worth the risk and the money.

[foreverinbluejeans]

You can pump and nurse at the same time. This is a great option. It super stimulates the lactation hormones and can increase your supply. It saves time. You take advantage of the baby stimulating the let-down reflex. Even if you didn't go with solids only while you work you don't need more than 8 oz a day the three days your work. It seems like there shouldn't be any problem pumping 24 oz a week, less than 4 oz a day. You say you can pump 2-3 oz a session. You could pump just once or twice a day and have enough.  

You can go with solids that are low risk for allergy. Baby food has a lot of water and few calories. Sweet potato and avocado are excellent choices. If your baby is below the 5th or 3rd percentile and there is a concern about weight gain (not just "not on the curve" of the weight chart) you can add butter or olive oil to the food the baby eats. Fat has 3 times the calories of carbs. Oatmeal is a low risk grain. There is evidence that it may be better for babies to be exposed to many different foods before 12 months to avoid allergies. There was a study that looked at all the studies about food allergies and it found that there is no reason to wait until after 12 months for foods on the list of most alleries including peanuts. You can find out more on the AAP website.

Babies with food allergies almost always have eczema. If your baby doesn't have eczema then the problems may not be a true allergy. My grandson has multiple food allergies. He is almost 3 and has had head to toe eczema since he was around 9 months. Tests only exist for a limited number of foods. He is allergic to peanuts, eggs, chicken, beef, rice and others. He isn't allergic to milk, soy, wheat and other common foods. The egg allergy is the hardest to live with.

Breastfed babies can overeat when they take bottles. The fat content of the milk is all mixed up in the bottle. When babies nurse they get low fat milk and then high fat that signals to them that they are full. He may not "need" as much breastmilk as he takes by bottle. If he overeats it may cause digestive or stool problems, make him nurse less well, or make him eat solids less well. If your tummy feels bad you don't eat well. Small amounts of breastmilk by bottle are better.

[PatioGardener]

Originally Posted by CheriK 

Other things to consider is if you have any pump parts failing,

This is always my first question when output drops! Is it the pump?

Good luck!