Using domperidone to increase breast milk supply: a clinical practice survey of Australian neonatal units

Abstract

Background Domperidone may be used off‐label to increase breastmilk supply. In the absence of manufacturer dosage recommendations, there is a need to compare the clinical practice guidelines used in Australian hospitals. Aim To compare existing clinical practice guidelines regarding the use of domperidone for increasing maternal breastmilk supply within Australian neonatal units (NNUs). Methods An electronic survey was distributed from April to July 2015 to relevant staff at each Level III NNU across Australia. Results Responses were received from 16 of 22 (73%) NNUs. All 16 (100%) NNUs considered domperidone their first line pharmacological agent of choice in the management of low milk supply, with 12 (75%) having a clinical guideline. Of the NNUs with a guideline, 11 (92%) recommended a standard maintenance dose of 10 mg three times daily (TDS). Duration of treatment was specified in 10 (83%) guidelines. Seven of 10 (70%) recommend a minimum duration of at least 2 weeks treatment before evaluating a response. Three of 11 (27%) guidelines that recommended 10 mg TDS permitted an increase to 20 mg TDS depending on response. Ten of 12 (83%) guidelines were modified in the previous 2–3 years, with eight revising their maximum dose to 30 mg/day, one limiting treatment duration to 7 days, and one removing the authority of NNU doctors to prescribe domperidone. Conclusion While all Australian neonatal units consider domperidone first‐line for pharmacological management of low milk supply, variability across clinical guidelines may suggest a lack of reliable evidence or awareness of evidence on which to base practice.

Domperidone for increasing breast milk volume in mothers expressing breast milk for their preterm infants: a systematic review and meta‐analysis

“…In addition, eligible studies where domperidone was prescribed for a minimum of 5 days following randomisation. The minimum duration of treatment was determined to be 5 days as this reflects the shortest duration of treatment identified in a recent clinical practice survey . Studies published only as abstracts were eligible for inclusion providing there was sufficient information presented in the abstract to demonstrate that the study met the inclusion criteria.…”

“…6 Previous studies have demonstrated that use of domperidone is widespread [7][8][9] with a recent clinical practice survey from Australia and New Zealand identifying that domperidone is considered the first-line in the treatment of low milk supply in the Neonatal Unit setting. 10 Despite high frequency of use, controversy surrounds the use of domperidone, with key issues related to the regulatory status of domperidone. 11 Domperidone has been the subject of regulatory warnings due to concerns regarding its QTc interval prolongation effects, but the relevance of these findings to younger, healthier lactating women has been questioned.…”

“…One of the best‐studied and most commonly utilised galactagogues is domperidone, a dopamine receptor antagonist that is thought to increase breast milk supply by increasing serum prolactin levels . Previous studies have demonstrated that use of domperidone is widespread with a recent clinical practice survey from Australia and New Zealand identifying that domperidone is considered the first‐line in the treatment of low milk supply in the Neonatal Unit setting …”

Pharmacological management of common lactation problems

“…Treatment durations range from 7 days to 6 weeks, although longer durations are seen in practice. There is an absence of evidence for one approach over another . Treatment should be tailored to the individual, based on identified risk factors or causes of low milk supply.…”

Phone calls to an Australian pregnancy and lactation counselling service regarding use of galactagogues during lactation – the MotherSafe experience

“…While non‐pharmacological strategies remain first‐line approaches to increasing breast milk supply, pharmacological treatment with medications used to augment lactation, known as galactagogues, are commonly recommended . The most frequently utilised galactagogue in clinical practice is domperidone, followed by use of metoclopramide or herbal medications such as fenugreek or milk thistle. While data on use of such galactagogues in clinical practice remains scarce, data from an Australian tertiary level maternity hospital demonstrated a significant increase in the number of women dispensed domperidone, from <0.5% in 2000 to >5% of total pregnancies in 2010, with approximately 50% of use among mothers of infants admitted to neonatal intensive care or special care units .…”