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FAQ: Domperidone (Motilium)

post #1 of 442
Thread Starter 
Domperidone (brand name Motilium) is a prescription galactogogue, similar to Reglan but with fewer side effects. Since it is a prescription drug, it should only be used as a last resort after it has been determined that you really do have a low milk supply or failure to thrive (FTT) situation. While it is generally considered safe, most people discuss using it with their family doctor, ob/gyn, or pediatrician before resorting to using this drug.

The best info on this drug is found on the kelly mom site and includes info on usage, dosage, politics behind its use and non-use, legality, medical journal articles about its use, etc.

More info is found on the BFAR site .

Domperidone can be obtained in the US from compounding pharmacies, or on the internet without prescription from:


http://www.inhousepharmacy.com/general/motilium.html

I’m going to be asking that this thread be stickied, so if anyone else wants to add info here please do so.

Edited to remove the globaldrug link. Apparently it is no longer in business.

Edited to add information from Thomas Hale, Ph.D., "Medications and Mother's Milk."

“It is also known to produce significant increases in prolactin levels and has proven useful as a galactagogue. Serum prolactin levels have been found to increase from 8.1 ng/mL to 124.1 ng/mL in non-lactating women after one 20 mg dose (Brouwers JR et al. Plasma prolactin levels after acute and subchronic oral administration of domperidone and of metoclopramide: a cross-over study in healthy volunteers. Clin Endocrinol (Oxf) 1980; 12(5):435-440.) Concentrations of domperidone reported
in milk vary according to dose. But following a dose of 10 mg three time daily, the average concentration in milk was only 2.5 micrograms/L (Hofmeyr GJ et al. Domperidone: secretion in breast milk and effect on
puerperal prolactin levels. Br J Obstet Gynaecol 1985 Feb;92(2):141-4)”

“Recently the US FDA issued a warning on this product stating that it could induce arrhythmias in patients. These claims were derived from data many years old where domperidone was used intravenously as an antiemetic during cancer chemotherapy (20 mg stat followed by 10 mg/kg/24 h). Many of these patients were undergoing extensive chemotherapy and were extremely ill, and hypokalemic to begin with.
Further, intravenous domperidone produced plasma levels many times higher than oral use. Thus far, we do not have any recently published data suggesting that domperidone used orally in breastfeeding mothers
is arrhythmogenic.”

“Lactation Risk Category: L1 (the safest level)
Pediatric Concerns: None reported. Considered the ideal galactagogue.”

Just as a point of reference, Ibuprofen is an L2, and Naproxen is an L3.

Here's a listing of its availability internationally:

Classification status in other countries:
•Australia: prescription medicine
•UK: over the counter (OTC)
•USA: not marketed
•Canada: prescription medicine
•Belgium: OTC
•Ireland: OTC
•Italy: OTC
•Japan: OTC
•Netherlands: OTC
•South Africa: OTC
•Switzerland: OTC

HTTP://WWW.MEDSAFE.GOVT.NZ/DOWNLOADS...OMPERIDONE.DOC

More sources of where you can get it, US and worldwide:

http://www.breastfeedingonline.com/d...onewhere.shtml

ETA

Link to package insert, including contraindications and possible drug interactions:

http://www.medsafe.govt.nz/Profs/Dat...otiliumtab.htm

ETA: PLEASE NOTE that offering to buy/sell Domperidone on MDC forums is against the User Agreement. Please don't discuss this here -- or this thread might be deleted.
post #2 of 442
There are side effects to domperidone, like any drug. It prolongs the QT interval of your heart, basically meaning if you have a heart issue, you should be very careful taking this drug.

Most importantly, taking this with ANOTHER drug that prolongs the interval can be risky. Some of these drugs are common for bf moms to take- like diflucan and some antibiotics.

I take dom (it helps but does not solve my supply problem), and just had to take two weeks of diflucan for a milk duct thrush infection, so I reduced my dom dose to 90 mg/day from 120/day. I think it is important to keep this in mind when taking dom, especially for those people who take more than recommended on the sites we have (kellymom/Dr. Newman's site). Just wanted to give a heads up! -Jenny
post #3 of 442
Thread Starter 
Dosage information:

http://www.kellymom.com/newman/19a-domperidone1.html

Quote:
Using Domperidone

Generally, we now start domperidone at 30 mg (three 10 mg tablets) 3 times a day. In some situations we go as high as 40 mg 4 times a day. Printouts from the pharmacy often suggest taking domperidone 30 minutes before eating, but that is because of its use for digestive intolerance. You can take the domperidone about every 8 hours, when it is convenient (there is no need to wake up to keep to an 8 hour schedule—it does not make any difference). Most mothers take the domperidone for 3 to 8 weeks, but sometimes it is needed longer than that, and sometimes it is impossible for mothers to maintain their milk supply without staying on domperidone. Mothers who are nursing adopted babies may have to take the drug much longer. People taking domperidone for stomach disorders are often taking it for many years.

After starting domperidone, it may take three or four days before you notice any effect, though sometimes mothers notice an effect within 24 hours. It appears to take two to three weeks to get a maximum effect, but some mothers have noted effects only after 4 or more weeks. It is reasonable to give domperidone a trial of at least four, and better, six weeks before saying it doesn’t work.

For more information on how to wean off the domperidone see the handout: Domperidone 2.
post #4 of 442
Quote:
Originally Posted by jenny-g
There are side effects to domperidone, like any drug. It prolongs the QT interval of your heart, basically meaning if you have a heart issue, you should be very careful taking this drug.

Most importantly, taking this with ANOTHER drug that prolongs the interval can be risky. Some of these drugs are common for bf moms to take- like diflucan and some antibiotics.
More to the point, it *can* prolong the QT interval, as can many other drugs. It doesn't in every individual (or even the majority) and of course the effect is seen more often in higher doses & those with preexisting heart arrhythmias.

It's still safer than Reglan, and far superior to artificial formula.
post #5 of 442
dont know about anyone else but the global drug link above didnt work for me, here it is with dom as a query: http://www.globaldrug.tv/search.asp?...ds=Domperidone
post #6 of 442
Thread Starter 
TIMING OF DOSAGE

From http://www.bfar.org/domperidone.shtml

Quote:
Maximizing Absorption

A study by Heykants (1) has shown that absorption of domperidone increases from 13% to 23% if domperidone is given ninety (90) minutes after eating. This means that the drug will act most effectively when mothers take it an hour and a half after eating.
post #7 of 442
Thread Starter 
Good news about Domperidone in US:

http://www.bfar.org/members/fora/ind...showtopic=2938

Quote:
A US Federal Judge ruled that compounding pharmacies in the US can make any drug they wish and cannot be restricted by the FDA (Federal Drug Adminstration) -- that the FDA has no jurisdiction over them. This is fantastic news for being able to get domperidone in the US. This means all those drastic warnings from the FDA to compounding pharmacies threatening legal action if they made domperidone are now negated. Any US physician can prescribe domperidone and any US compounding pharmacy can make it LEGALLY.

http://www.iacprx.org/site/PageServe...eleases#052606
http://www.aapsonline.org/nod/newsofday294.php

A very big day for domperidone. Please spread the news.

Diana West
(She is the author of Defining Your Own Success and the upcoming Making More Milk: A Nursing Mother's Guide to Milk Supply)

post #8 of 442
Thread Starter 
post #9 of 442
Thread Starter 
post #10 of 442
Wow, I hadn't heard about the compounding pharmacy ruling. That's fantastic! A few months ago when I had an order from New Zealand seized in customs, I was scrambling to go to a compounding pharmacy, and was told there that if the FDA told them to stop, they'd have to stop and destroy all the Domperidone they had- basically that day.. So ultimately, it could have meant for some women (who don't want to buy off the internet) that they can't make the milk their babies need.

Anyway, I'm glad to read that.
post #11 of 442
To the poster who had her dom order customs-zapped: remember, ask on here if that happens again if you need any to tide you over the time it takes to get a new order. I just got a big order for myself in past customs, and I'm happy to help anyone else out who isn't so lucky. Of course, now, with the compounding pharmacy option, that will help people out too!
post #12 of 442
Is there any way to help your order not get shipped back? I know customs probably stops based on certain criteria, also just randomly I'd guess. I didn't know if there was anything to help your order get through and be shipped?

I plan on ordering dom in the future.
post #13 of 442
Thread Starter 
I don't know of any strategies, but I have heard there are more confiscations at the end of the year (November / December). Don't know if they have a quota or if it's just increased mail traffic with the Christian holidays.
post #14 of 442
Thread Starter 
post #15 of 442
Thread Starter 
post #16 of 442
How do you know if a pharmacy is a compounding pharmacy? Is there an online list or something to see if there's one near me? I would rather get it by prescription so I would only have to pay a small co-pay for it and I wouldn't have to worry about shipping and customs.
post #17 of 442
I called my local pharmacy and asked them if there was a compounding pharmacy in the area, and they had no problem giving me a number of a place just 20 minutes away.
post #18 of 442
This website can also help you find a compounding pharmacy:

http://www.iacprx.org/site/PageServe...=lookup_survey
post #19 of 442
Thanks! Now to get my doc to write an Rx...that will be the hard part.
post #20 of 442
Just FYI- it was $130 dollars a week to have it compounded, and $150 for almost three months worth when I got it from New Zealand.
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