Information for breastfeeding mothers
This fact sheet has been written about how to use this medicine in breastfeeding mothers of children being treated at Queensland Children’s Hospital (QCH). This information sometimes differs from that provided by the manufacturers, because their information is usually aimed at patients taking domperidone for another reason. Please read this information carefully and keep it somewhere safe so that you can read it again.
Domperidone is not recommended for use in mothers with cardiac arrhythmias or mothers taking any medication which may cause cardiac arrhythmias. 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.
There is very limited transfer of domperidone to babies whose mothers are taking this medicine to increase breast milk supply and no published information to suggest it causes cardiac effects in babies. The Cardiac Team at QCH have reviewed the available information about this, and are happy to continue to use domperidone in otherwise well-breastfeeding mothers of babies being treated at QCH.
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 can this medication help breastfeeding mothers?
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 (Motilium ®) is the most effective medicine used to improve breast milk supply. This is a medication that 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 around the world and in Australia for this purpose and your doctor will consider the following before prescribing this for you:
- 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 the medicine.
- Ensure you are prescribed domperidone at the lowest effective dose and increase the dose as needed based on you, or your baby’s response, or as directed by the doctor.
- Ensure regular follow-up, while you are taking domperidone, to monitor that it is working to increase milk supply, and to look for any side-effects or adverse reactions.
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 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, in consultation with your regular GP.
How should I take it?
- The tablets can be swallowed with some water.
- The tablets can also be dispersed in a small amount of water (5 mL), which is then swallowed, followed by some water.
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 if I am sick (vomits)?
- 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 if I forget to take it?
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.
Never take a double dose of the amount of domperidone prescribed.
What if I take too much?
Too much domperidone can make you feel uncomfortable, with more side effects
Contact the Queensland Poisons Information Service on 13 11 26.
Are there any possible side effects?
Sometimes domperidone might have other effects that we don’t want (side effects).
Side effects you must do something about
- Dizziness, fainting or heart palpitations. Stop taking domperidone and seek medical attention
- Muscle spasms
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.
Can other medicines be taken at the same time as domperidone?
- When you are breastfeeding, it is important to check all medicines that you want to take with your lactation consultant, pharmacist or doctor. Some medicines might affect your milk supply, or be transferred in the milk to your baby.
- Domperidone should not be taken with some other medicines that you get on prescription or over the counter at a community pharmacy without checking first. Tell your doctor and pharmacist about any other medicines you are taking before starting any new medicine.
- Domperidone can interact 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.
Where should I keep this medicine?
- 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.
- Make sure that children cannot see or reach the medicine.
- Keep the medicine away from pets.
General advice about medicines
- Try to take the medicine at about the same times each day. This will help you remember to take it every day.
- This medicine should only be used by you, and only for the required time to improve milk supply. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
- If you think someone else may have taken the medicine by accident, contact your doctor straight away or contact the Queensland Poisons Information Centre on 13 11 26.
- Make sure that you always have enough medicine. Contact your prescriber at least two weeks before you will run out. They will review whether a new prescription is required.
- Make sure that the medicine you have has not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.
Who to contact for more information
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.
Level 2, Queensland Children’s Hospital
501 Stanley Street, South Brisbane, QLD 4101
t: 07 3068 1901
In an emergency, always call 000 for immediate assistance.