Audit of Domperidone Use as a Galactogogue at an Australian Tertiary Teaching Hospital

Grzeskowiak, Luke E.; Lim, Sze Wen; Thomas, Alicia E.; Ritchie, Usha; Gordon, Andrea

doi:10.1177/0890334412459804

Cited by 31 publications

(53 citation statements)

References 21 publications

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“…We found that galactogogues were frequently prescribed and used by more than half of the participants, which is higher than in high-income settings internationally, where a 5 -33% prevalence of galactagogue use has been documented. [11,12] In our study, supplements were the most preferred galactogogues, with the use of fenugreek and berry elixir-containing juices being widespread, often in combination with prescription medications. Safety and efficacy data supporting the use of galactogogue supplements are limited.…”

Section: Discussionmentioning

confidence: 71%

A cross-sectional descriptive study of breastfeeding behaviour and galactogogue use among private-sector patients in Cape Town, South Africa

Zunza

Decloedt

2017

S Afr J OG

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Background. Failure to exclusively breastfeed is often caused by a perception of insufficient breastmilk supply. Galactogogues are frequently prescribed in these circumstances, but this is supported by sparse scientific data with safety concerns for both mother and infant. The exact extent of galactogogue use in South Africa (SA) is not well known. Objectives. To assess breastfeeding behaviour, galactogogue use and perceived galactogogue side-effects among patients attending International Board Certified Lactation Consultant (IBCLC) private practices. Methods. We administered a self-developed, expert-reviewed questionnaire in five IBCLC private practices within the Cape Town Metropole, SA. All patients attending the practices during an 8-week period were invited to participate. Results. Data from 104 participants were included in the study. An exclusive breastfeeding rate of slightly more than 50%, associated with greater parity (p=0.029), was found. Perceived lack of breastmilk predicted galactogogue use (p=0.013). There was a high prevalence of galactogogue use (54%), with 80% of these participants using non-prescription medication. Sulpiride was the most common prescription medication used. Increased milk production was reported by 41% (n=23) of galactogogue users, while 30% (n=17) reported no effect. Most reported side-effects were minor. Conclusions. Prevalence of galactogogue use exceeded other published data. Sulpiride was most frequently prescribed, despite not being recommended during breastfeeding. A large group of participants reported poor efficacy. The effect of vaginal delivery and immediate skin-to-skin contact after delivery on milk production might be smaller than previously reported in mothers who are personally motivated to breastfeed. Healthcare practitioners should acknowledge breastfeeding mothers' concerns regarding insufficient milk supply and emphasise correct breastfeeding technique. Exclusive breastmilk is the optimal feeding for infants up to 6 months of age. S Afr J Obstet Gynaecol[1] Breastfeeding has been associated with short-term benefits such as providing the child's first immunity and reducing infant morbidity and mortality associated with infections.[2] Long-term benefits include lower mean blood pressure and total cholesterol in adulthood, and improved performance in intelligence tests. [2] However, mothers struggle to achieve exclusive breastfeeding and according the World Health Organization (WHO)᾽s global database on infant and young child feeding the rate of exclusive breastfeeding in South Africa (SA) is among the lowest in the world, at 11.6% in infants <4 months and 8.3% in infants ≤6 months of age, compared with a global rate of 38%.[3] There are many contributing factors leading to low breastfeeding rates, but the most common reason is insufficient breastmilk supply. [4] Galactogogues are often prescribed to augment breastmilk supply in resource-rich environments.[5] Galactogogues are dopamine antagonists such as antipsychotics, antiemetics and natural supplements wh...

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Section: Discussionmentioning

confidence: 71%

A cross-sectional descriptive study of breastfeeding behaviour and galactogogue use among private-sector patients in Cape Town, South Africa

Zunza

Decloedt

2017

S Afr J OG

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“…The demand for galactagogues appears to be increasing, as do some risk factors for physiologic issues related to insufficient lactation, such as obesity, increasing maternal age at delivery, and caesarian section 29,31,32. Women with physiologic issues will rely on their health provider’s advice to support them.…”

Section: Discussionmentioning

confidence: 99%

Health provider experiences with galactagogues to support breastfeeding: a cross-sectional survey

Bazzano

Littrell

Brandt

et al. 2016

JMDH

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BackgroundExclusive breastfeeding for infants up to 6 months is widely recommended, yet breastfeeding rates are relatively low in the US. The most common reason women stop breastfeeding early is a perceived insufficiency of milk. Galactagogues are herbal and pharmaceutical products that can help increase milk supply; however, data on their efficacy and safety is limited. Lactation consultants, obstetricians, and other health providers are an important point of contact for breastfeeding women experiencing challenges with lactation. This study explored providers’ perceptions, experiences, and practices in relation to galactagogue recommendation.MethodA cross-sectional survey was conducted among a convenience sample of English-speaking health providers in the US who counsel breastfeeding women and their infants.ResultsMore than 70% of respondents reported to recommend galactagogues. The most frequently recommended galactagogue was fenugreek with respondents indicating that they recommend it either ‘always’ (8.5%) or ‘most of the time’ (14.9%) and ‘sometimes’ (46.8%). More than 80% of the respondents indicated that galactagogues were useful for their clients and only one-third reported side effects. Reasons for refraining from recommending galactagogues were insufficient evidence of its efficacy and safety. Respondents reported a wide variety of sources of information used for their own education about galactagogues.DiscussionDespite little evidence regarding safety and efficacy, some galactagogues are widely recommended and often perceived to be useful. However, concerns about their efficacy and safety remain. In order to assure both providers and users about safety and efficacy, more robust studies as well as better pharmacovigilance systems are needed.

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“…Domperidone is used for nausea and vomiting [10] associated with migraine [11], gastroparesis [12], in combination with levodopa in the management of Parkinson's disease [13], functional dyspepsia [14], in lactation acting as an antidopaminergic agent to promote lactation [15,16].…”

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confidence: 99%

Formulation of Domperidone Microspheres Using a Combination of Locally Extracted Chitosan and Hpmc as Polymers

Majekodunmi¹,

Uzoaganobi²

2017

JCCE

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Abstract:Commercially available domperidone -a D2 receptor antagonist-is an immediate release formulation which has never been formulated into microspheres for sustained release. The present work aims towards studying the effect of combination of a natural chitosan from an oyster shell of Mystilis edulis and HPMC (hydroxy propyl methyl cellulose) (spectracel 15 E) as polymer and tripolyphosphate as cross linking agent using wet gelation technique. The various polymer combination ratios for different batches were compared with a low molecular weight standard chitosan. The extracted chitosan -HPMC polymer combination ratios were chosen at ten levels: as batches B1, B2, B3, B4, B5, B6, B7, B8, B9, B10 for 1:1, 1:2, 2:1, 1:0, 0:1, 3:1, 1:3, 5:1, and 1:5 and 1:1 having 450:450, 300:600, 600:300, 900:0, 0: 900, 675:225, 225:675, 750:150, 150:750, 450:450 mg respectively, while the quantity of domperidone and tripolyphosphate remained constant. B11 and B12 were formulated with standard chitosan and HPMC. The percentage yield of the formulated microspheres was determined and then evaluated for flowability, drug entrapment efficiency, drug release and mechanism of drug release by Fickian diffusion. The best batches of the domperidone loaded microspheres produced from the combination polymer were compared with the standard chitosan. The highest yields of microspheres were given by batches B12, B11, B10, and B4 with values of 50.1 ± 0.1%, 49.6 ± 0.1%, 46.6 ± 0.1%, and 46.1 ± 0.0% respectively while the lowest yield were 23.3 ± 0.2% and 23.6 ± 0.2%. B5 and B6 and B9 did not yield any microsphere. The bulk density, tapped density, compressibility and Hausner's ratio of the microspheres showed good flowability and high percent compressibility. The drug entrapment efficiency showed that the entrapment ranged from 54.2 to 97.2, where the least entrapment was B4 (54.2 ± 0.1) and the highest B12 (97.2 ± 0.2). The polymer surface of the microspheres as observed by SEM (scanning electron microscopy) was heterogeneous and porous which offers enhanced bioadhesivity. The dissolution study was used to determine the percentage drug release which ranged from 12.1% to 68.9% after 5 hours. Batches 1, 2, 3, 4, 7, and 11 follow zero order kinetics via Fickian diffusion. The results indicate that microspheres of domperidone could be successfully formulated with a natural chitosan either alone or in combination with HPMC for sustained delivery of domperidone. Furthermore, the concentration of the natural polymer and HPMC employed in the formulation need to be carefully selected to enable the production of microspheres with the desired sustained release properties.

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Audit of Domperidone Use as a Galactogogue at an Australian Tertiary Teaching Hospital

Cited by 31 publications

References 21 publications

A cross-sectional descriptive study of breastfeeding behaviour and galactogogue use among private-sector patients in Cape Town, South Africa

A cross-sectional descriptive study of breastfeeding behaviour and galactogogue use among private-sector patients in Cape Town, South Africa

Health provider experiences with galactagogues to support breastfeeding: a cross-sectional survey

Formulation of Domperidone Microspheres Using a Combination of Locally Extracted Chitosan and Hpmc as Polymers

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