Domperidone is a dopamine antagonist with antiemetic
and gastroprokinetic properties.1 It is indicated
for the symptomatic management of upper
gastrointestinal motility disorders and gastrointestinal
symptoms associated with the use of dopamine agonist
antiparkinsonian agents.1
Breastfeeding is recommended for all infants, with
very few exceptions, as there are many benefits for
the developing child, including evidence for improved
cognitive development, reduced incidence of infection,
and less risk of sudden infant death syndrome.2
Further, there is evidence of benefits for the mother,
such as reduced incidence of reproductive cancers.3
Some women, however, experience insufficient breast
milk production. Domperidone has been demonstrated
to induce and maintain lactation by increasing
prolactin levels.4 A recent systematic review and
meta-analysis by Motherisk demonstrated a statistically
significant increase of 74.7% (95% CI 54.6 to 94.9,
P < .001) in daily milk production following treatment
with domperidone and found no maternal safety issues
when compared with placebo.5 At present, some intervention
trials are under way to define the appropriate
dose in specific populations (eg, mothers of preterm
infants). Only minimal amounts of domperidone are
excreted into breast milk (less than 0.1% of the maternal
weight-adjusted dose), and side effects in breastfed
infants have not been reported.3,6-8 Therefore, when
nonpharmacologic treatments fail or are inadequate,
domperidone might be an option.