(Motilium) as a Galactogogue
|Reviewed by Carol Thomas and Carl Kuschel|
Domperidone is a peripheral dopamine-receptor antagonist used in the treatment of dyspepsia, reflux oesophagitis, and nausea and vomiting. One of its side effects is an increase in prolactin levels 1, 2.
Unlike metoclopramide that works centrally, domperidone works on peripheral dopamine receptors in the GI wall and CTZ centre of the brainstem 1. Its effects on prolactin secretion occurs at the pituitary level (outside the blood-brain barrier) 2. Domperidone is less lipid soluble, has a larger molecular weight (426), and is highly protein bound (93%) 1, as compared to metochlopramide. Combined with the peripheral action this results in fewer central side effects such as anxiety, depression and extrapyramidal symptoms 2 and less medication crossing through into breastmilk. Because domperidone crosses less freely into breastmilk (compared with metoclopramide) the possible risks to the infant are also reduced 3. There has been some concern of the possible effect of dopamine antagonists on the functional maturation of central dopamine mechanisms in newborns (identified in experiments on rats) 4.
Da Silva showed a milk domperidone concentration of 1.2ng/ml, after a dose of 10mg three times per day, measured on day 5 from randomly selected samples 2. This is compared with 125.7ng/ml of maxalon from milk samples taken 2 hours after a dose of 10mg of metoclopramide 4
Domperidone has been approved by the American Academy of Pediatrics (AAP) for use in breastfeeding 1 and is currently the only galactogogue that has been scientifically evaluated through a randomised, double-blind placebo-controlled trial 3. This trial by da Silva et al 2 showed milk volume increased by 44.5% in the domperidone group compared with 16% in the placebo group (p<0.05). There was a steady increase in milk volume commencing 48 hours after initiation of treatment up until day 7, which was the last day of medication. This correlated with a rise in serum prolactin in the domperidone group, rising from 12.9 trial μ /L [SD7.7], measured as baseline, to 119.3 [SD97.3] μ/L of a randomly sampled blood test on day 5. The serum prolactin levels returned to baseline 3 days after treatment was ceased.
|1||Hale. Domperidone. Medications and Mothers’ Milk 2002: 10th Edition;230-231|
|2||da Silva et al. Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial. CMJ 2001;164(1):17-21.|
|3||Gabay. Galactogogues: Medications that induce lactation. J Hum Lact 2002;18(3):274-279.|
|4||Hofmeyr et al. Domperidone: secretion in breast milk and effect on puerperal prolactin levels. Br J Obs Gynae 1985; 92:141-144.|
|5||New Ethicals Catalogue. Adis International. May-Nov 2002; 256|