Domperidone for breastfeeding: What does the evidence tell us?

Breastfeeding is important to infant and maternal health, but new mothers often experience difficulties. Domperidone, a gastric motility drug, has been widely used “off-label” to stimulate milk supply, and was prescribed to 19 percent of postpartum women in BC in 2011. Domperidone is subject to Health Canada safety advisories due to QT prolongation, serious cardiac arrhythmias, and sudden death.

This team conducted a CIHR-funded systematic review of domperidone use in breastfeeding. Based on randomized controlled trial (RCT) data, there is a modest (76 ml/day) increase in milk production after preterm birth, but no evidence of infant or maternal health benefits or improved breastfeeding rates. Most use in BC is at high doses (above the 30 mg/day maximum recommended by Health Canada) and after full-term births, for which RCT evidence is lacking. Cardiac risks are increased at high doses. Based on observational studies, these extend to women of reproductive age and infants. Overall, benefits fail to outweigh harm.

This project will carry out knowledge translation activities to disseminate review findings. In April 2017, the team hosted a symposium at UBC to share preliminary results with midwives, lactation consultants, physicians, nurses, academics and policy makers, and to discuss their implications. Many participants were unaware of the lack of evidence supporting use, and expressed an urgent need for additional activities to share results with their networks and with breastfeeding mothers.

This project's goal is to enhance informed shared decision-making when women experience breastfeeding difficulties, aiming to support more judicious domperidone prescribing and use, in keeping with the evidence on benefits and harm. An integrated knowledge translation approach will be used, with planned activities tailored to key stakeholders:

• A webinar for pharmacists, nurse practitioners, midwives and physicians in BC.
• An in-service program to clinicians in urban and rural BC.
• Online resources for consumers for dissemination through BC breastfeeding networks and social media materials (e.g. infographics, “tweetable” key messages).
• A treatment decision support summary for physicians on "Pathways”.
• A Therapeutics Letter, mailed to BC family doctors and pharmacists and posted online (with online podcast).

Information on domperidone will be accompanied by materials on alternative non-drug options to support breastfeeding. All materials will be shared with perinatal and postpartum educators, with the aim of a “snowball” effect. To evaluate knowledge translation outcomes, uptake will be assessed, including shifts in treatment protocols, through clinician and consumer feedback.