NDC Clinical Guidelines Induction of Lactation Part 3. Does domperidone result in improved breastmilk volumes during non-puerperal induction of lactation?

NDC Clinical Guidelines Induction of Lactation: Use of domperidone as part of mammary gland preparation for induction of lactation is biologically plausible

Domperidone has been shown to increase breast milk production in the breasts of mothers of prematurely born infants, whose breasts have not have not had opportunity to fully mature. Because of this finding, the use of domperidone to aid in breast preparation for induced lactation is biologically plausible. However, there is no evidence to show the domperidone improves breastmilk volumes in induction of lactation. The most important factor in induction of lactation is nipple and breast stimulation.

• Domperidone 10 mg three times daily has been shown to be effective as a galactogogue in mothers of preterm infants. There is no evidence to support 20 mg three times daily, although this is the dose I often prescribe.

• The Newman Goldfarb recommendation of 20 mg four times daily also lacks an evidence-base, and increases the risk of side-effects. You can find out about domoperidone's side-effects here.

Plasma prolactin levels do not correlate with milk volume or rate of milk synthesis in mothers of term infants

Time frame	Baseline prolactin levels ng/ml
Non-pregnant	10
Peak at birth	200
10-90 days post-birth	60-110
3-6 months post-birth	50-100
6 months + post-birth	30-40

• Prolactin levels rise in a pulse after nipple stimulation and suckling, peaking about half an hour after the baby starts to suckle.

• Prolactin secretion varies with the circadian rhythm, resulting in serum levels being two or three times higher at night than during the day (including when not breastfeeding), peaking between two and six in the morning. There is no good physiological rationale to the belief that night-time breastfeeds increase milk production because of the effect of night-time breastfeeds on prolactin levels. It is more likely that long periods overnight without milk removal are responsible for decreased milk production if a woman isn't breastfeeding during the night, due to raised intra-alveolar pressures. You can find out about downregulation of milk secretion here.

• Baseline and peak levels are highly variable between women and do not correlate with a woman’s milk volumes or rate of milk synthesis.

• Frequent and flexible breastfeeds aren't likely to result in upregulation of milk secretion because of stimulation of prolactin and oxytocin. You can find out about the mechanisms more likely to underlie the upregulation of milk secretion here.

• Women with low breastmilk supply don’t usually have low prolactin levels.

Taper the dose of domperidone prior to complete cessation

If domperidone is used, it's important to taper the dose of domperidone slowly when it's time to cease, and cessation can result in insomnia, anxiety, headaches, palpitations, gastro-intestinal disturbances, depression, or recurrence of any previous psychiatric symptoms

• More about domperidone use in lactation, including side-effects, is found here.

• Information about ensuring patient safety when commencing domperidone is found in the NDC Resource Hub (domperidone safety check list).