http://www.bfar.org/domperidone.shtmlDomperidone
(Motillium™)An excerpt from "Defining Your Own Success: Breastfeeding After Breast Reduction Surgery"
Domperidone (Brand name "Motilium™")
Domperidone, brand name Motilium™, is a prescription drug that is generally used for adult and pediatric gastrointestinal disorders, but which has been clinically and anecdotally shown to also have a dramatic effect upon the milk supply. It achieves this effect by suppressing the neurotransmitter dopamine, which is a prolactin inhibitor. Prolactin, then, is produced in significantly greater quantities, compensating for nerve damage in BFAR mothers.
Many BFAR mothers choose to use domperidone because it is dramatically effective in increasing the milk supply and does not have the negative central nervous system (CNS) effects common to other prescription galactogogues such as metoclopramide (Reglan™). The reason that domperidone does not have these side effects is because, unlike metoclopramide, it does not cross the blood-brain barrier. Drugs that cross the blood-brain barrier are more likely to cause detrimental CNS side effects.
Dr. Jack Newman has prescribed domperidone for many years in his clinic in Toronto, Canada, for appropriate breastfeeding situations when normal prolactin stimulation cannot be achieved. Many other physicians also prescribe domperidone for this purpose.
It can be purchased in the United States from some compounding pharmacies and is available by mail-order from pharmacies in Canada, New Zealand, Germany, Australia, and Mexico. The fact that domperidone is difficult to obtain in US should not be mistaken as an indication that the drug is unsafe. In fact, the American Academy of Pediatrics (AAP) has approved it for use in breastfeeding mothers. Metoclopramide (Reglan™), the prescription galactagogue that is available in the US from non-compounding pharmacies, on the other hand, has been classified by the AAP as a drug, "whose effect on nursing infants is unknown but may be of concern."
Side effects of domperidone at the therapeutic dose are rare and minimal for both nursing mothers and infants. It is transferred into the milk in minute quantities, far below the therapeutic dose that is commonly prescribed for infants for gastrointestinal disorders.
Most mothers report an increase in their milk supplies within three to four days after beginning domperidone, although the response may occur sooner. The increase, however, builds over the first few weeks and does not reach the maximum effect until around the third week. The galactogenic effect will subside when the drug is discontinued.
TABLET THERAPEUTIC DOSE
20-40mg, 3-4 times per day during daytime, preferrably an hour and a half after meals.
POTENTIAL SIDE EFFECTS
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.
Reference
References
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