Many mothers worry about if they are making enough milk for their baby.
It’s important to rely on reliable signs to tell if your baby is getting enough milk as opposed to unreliable signs.
However, some mothers do struggle to make a full supply. For such mothers, use of a galactagogue (a substance claimed to increase milk supply) can help.
Domperidone (Motilium™) has been around since the 1980s to treat gastric problems (e.g. nausea, vomiting, gastric reflux and gastric motility).
It has not been used for nearly as long as a galactagogue.
Good quality research has also shown Motilium works effectively as a galactagogue by increasing prolactin levels. Prolactin is the hormone which stimulates cells in the breast to produce milk.
When it comes to taking a drug, particularly during pregnancy or when breastfeeding, many mothers worry about various things such as how the drug might affect their baby and side effects.
Motilium (Domperidone) & Breastfeeding
Here are 5 common questions answered about the use of Motilium to increase supply when breastfeeding.
#1: When Might Motilium Be Considered?
There are other ways a mother can try to increase her supply without the use of a galactagogue. You can read these here. Frequent and effective milk removal is the most important factor in establishing and then maintaining a plentiful milk supply. Hence, anything that affects this can affect milk supply.
However, if a mother continues to have a low supply despite the above, Motilium may be considered.
Since Motilium increases prolactin levels, it’s primary use is for those with low prolactin levels (hypoprolactonaemia).
However, if a mother has a low milk supply that is unrelated to low prolactin levels, it’s still possible Motilium might help. For example, if:
- A mother has insufficient glandular (milk making) tissue (e.g. due to breast reduction surgery or breast hypoplasia), Motilium might help by super-stimulating/bombarding the existing glandular tissue to make up for any missing glandular tissue.
- Breastfeeding got off to a poor start (e.g lots of unnecessary supplementation ) resulting in a mother not establishing a full supply, Motilium might help by boosting prolactin surges and super-stimulating the glandular tissue.
Motilium may also be helpful for mothers to relactate, induce lactation, who struggle to express enough milk for a premature baby, or for any other reason where a low milk supply exists.
It’s important to note that Motilium does not work unless milk is removed often and effectively too.
#2: Does Motilium Have Any Side Effects?
With any drug, side effects are possible.
Another prescription and effective galactagogue called metoclopramide crosses the blood-brain barrier and hence can cause central nervous system (CNS) side effects (e.g. fatigue, irritability and depression).
In comparison, Motilium does not cross the blood-brain barrier and so doesn’t cause CNS side effects. In fact, few women taking Motilium as a galactagogue seem to experience any side effects at all. The few women who do experience side effects report:
- Headache
- Abdominal cramps
- Dry mouth
Very little Motilium gets into breastmilk. It’s so little that side effects in the baby should not be expected. In fact, Motilium has been given directly to babies to treat reflux and the amount the baby gets though breastmilk would be negligible in comparison.
In 2004, the use of Motilium as a galactagogue was questioned when the American FDA issued a statement suggesting domperidone could cause cardiac arrhythmias. Critics of this FDA statement have been numerous and justified. This is because the FDA statement came from data relating to very sick patients receiving very high intravenous doses of domperidone – hardly relevant to a lactating population of women.
To date, there have been no cases of adverse cardiovascular effects from oral Motilium use by breastfeeding mothers. Nonetheless, as a precaution, it’s been recommended to not prescribe Motilium to those with or suspected of having cardiac arrhymthmias.
#3: What Dosage Of Motilium Should Be Used?
Motilium has been shown to work as an effective galactagogue when used at doses of 10 to 20 mg, 3 to 4 times a day. In some situations, as guided by your doctor, higher doses might be given.
#4: How Long Will It Take To Work?
Some mothers may notice an increase in their supply within a few days of taking Motilium, while it may take a few weeks or more for others.
A trial of Motilium for 4 to 6 weeks is often needed before deciding if it doesn’t help.
#5: Will I Be Able To Wean Off Motilium?
Many mothers take Motilium between 3 and 8 weeks. However, sometimes it’s needed for longer. In fact, some mothers have found they need to take it until weaning to maintain their milk supply. People taking Motilium for gastric problems have often been taking it for many years.
To help prevent a rebound effect occurring, weaning off Motilium should be done gradually. For example one 10mg dose can be stopped every 4 to 5 days. If milk supply continues to be sufficient, another 10 mg dose can be stopped. This can be continued until the final does is taken, as long as there has been no decrease in milk supply or baby weight gain.
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If you have a low milk supply, see a lactation consultant. They will be able to help you work out if indeed you have a low supply and suggest ways to take to increase it. Provided milk is being removed often and effectively, a galactagogue such as Motilium may help.
