domperidone was being used for babies (and now that cisapride is off
the market, it is being used again), it was common for the babies to be
on the medication for several months, even longer. Since the amount of
domperidone that gets into the milk is very small indeed, from the
baby’s point of view, there should be no issue in the mother taking it
to increase milk supply for several months. Our experience with this
drug is that short-term side effects are very few and almost always very
mild. Worldwide experience with domperidone over at least two decades
suggests that long-term side effects also are rare. Some of the mothers
in our clinic, breastfeeding adopted babies, have been on the
medication for 18 months without any apparent side effects. As
mentioned in the information sheet Domperidone, Getting Started,
patients using domperidone for stomach disorders may be on it for many
years. We hope you won’t need domperidone for very long, but if it’s
necessary and helpful, stay on it.
How long does it take for domperidone to work?
It depends on the situation. In a situation where the mother had had a
good milk supply, but it decreased for some reason (e.g. going on the
birth control pill, see the information sheet Slow Weight Following
Early Good Weight Gain), domperidone often works very rapidly to
increase the milk supply. Often, within a day or two the mother is
seeing a difference (and so does her baby). But this is not always so,
and in many situations, it may take a week or more for the mother to
start getting an effect. On occasion, we have had mothers only starting
to get an increase in their milk supplies a month or more after
starting to take it. Therefore, we generally recommended that the
mother take the domperidone for at least six weeks in order to be sure
whether it has worked or not.
It is our impression that domperidone works best after the first few
weeks after the mother has given birth (usually after about four weeks).
This has not been proved, but there are theoretical reasons why it may
be so. For this reason, we have often waited to prescribe it until the
baby is at least three weeks, mainly because we did not want the mother
to become discouraged if she did not see any rapid increase in her milk
supply. If you keep this in mind, taking domperidone before three or
four weeks after the birth of the baby is worth a try because sometimes
it does work very well early on.
How do I know how long to take domperidone?
Usually, we ask the mother take it for at least two weeks at a minimum
and then re-evaluate the situation. There are several possibilities.
The milk supply has increased substantially, to the point where
there is no longer a consideration of using supplements, or the mother
has been able to stop supplements with the baby continuing to gain well
on breastfeeding alone.
The milk supply has increased to a point that the mother feels is
satisfactory. For example, she may still need to supplement, but the
baby does not fuss any more at the breast and drinks contentedly.
There has been little or no effect with the Protocol to Manage Breastmilk Intake and the domperidone. Often waiting or increasing the dose may help.
In the first situation (but not necessarily always in that situation),
we may suggest the mother start weaning herself from the domperidone in
- When you are ready to start weaning from the domperidone, drop
one pill, so that now, instead of nine pills a day, you will be taking
Wait four or five days, a week if you wish. If you see no change in your milk supply, drop another pill.
Wait another four or five days. If you see no change in your milk supply, drop another pill.
Continue in this way until you are down to no pills a day. If there has
been no decrease in your milk supply, or if there has been a small
decrease that does not affect the breastfeeding and baby’s weight gain,
that’s just what we hope to have happened, and many mothers manage this.
If, however, your supply diminishes significantly, return to the
previous effective dose and do not drop any pills for a couple of weeks
If you are keen to go off the domperidone, after a couple of weeks
on the same dose, start dropping a pill a day, as in step 1 above. Some
mothers, who were not able to get off the domperidone with steps 1-4
above the first time, can do it the second or the third time.
You may find that you have to continue a certain dose to maintain
your milk supply. But following steps 1-4 above will get you to the
lowest effective dose.
It is possible, however, that after two weeks of taking domperidone, you
are not where you want to be. In that case, you should continue using
the domperidone. If you are still not where you want to be after two to
six weeks of domperidone, it is time to think some more about the
domperidone. If you are supplementing, and have managed to reduce the
amount of supplement from 400 ml to 300 ml (14 ounces to 10 ounces), is
it really worth taking a drug in order to do this? I would say yes, but
this is up to you. If you feel it is, then continue with the
domperidone, but try weaning the number of pills down to minimum number
that maintain your milk supply, as above. If you do not feel it is
worth it, try weaning down as above, and if you don’t see any change
once you get to no pills a day, fine. However, if you do notice a real
change in the milk supply as you lower the dose, maybe the domperidone
is more effective than you had thought (remember, after several weeks,
your baby is significantly heavier, and it may be that instead of
needing 400 ml (14 ounces) without domperidone, the baby might actually
need 20 ounces to maintain good weight gain, in which case the
domperidone is actually doing something).
Remember: Before using domperidone, the breastfeeding should be fixed, and as quickly as possible. This means:
Getting the best latch possible. This alone may result in the baby getting enough milk.
Using compressions to increase milk intake by the baby.
“Finish” one side before offering the other (see Protocol to Manage Breastmilk Intake)
for an explanation on how to know the baby is getting milk and the
video clips on our website) to help you identify good drinking.
- Do not limit the baby to one side if the baby is not getting enough. Switch to the other side once the baby is no longer getting milk even with the compressions.
Switch back and forth, as long as the baby is getting good amounts of milk.
- Follow the Protocol to Manage Breastmilk Intake.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005
Revised by Jack Newman MD, FRCPC, IBCLC and Edith Kernerman IBCLC, 2008, 2009