Domperidone produces greater increase in breast milk supply than placebo: Study

While factors that affect breastfeeding success are multiple and nonmodifiable at times, the early recognition and timely management of modifiable risk factors is warranted to improve lactation performance. Various nonpharmacological interventions have been shown to be effective and hence are incorporated in the current clinical recommendations for promoting breastfeeding. Among them are individual and group breastfeeding education provided by lactation specialists, peer counseling, in-person, or telephone support. Pharmacological interventions to improve lactation, mainly dopamine antagonists, are usually recommended only after nonpharmacological modalities have failed, and this is largely due to scarcity of available evidence and potential safety issues with pharmaceutical galactagogues.

Domperidone, a peripheral dopamine receptor antagonist, is believed to enhance breast milk production by increasing prolactin secretion. It has a favorable safety profile when compared to metoclopramide, another dopamine receptor antagonist, with only rare extrapyramidal side effects owing likely to poor blood-brain barrier penetration of domperidone.

The objective of this study was to perform a systematic review and meta-analysis of the available data assessing the effect of domperidone on breast milk supply in women experiencing insufficient breast milk production.

Randomized controlled trials (RCTs) examining the effect of domperidone on breast milk production of puerperal women were eligible for inclusion. Absolute and relative changes from baseline were calculated for individual studies and pooled using a random effects model. Results. Three RCTs including 78 participants met the inclusion criteria. All showed a statistically significant increase in breast milk production following treatment with domperidone. The analysis of pooled data demonstrated a statistically significant relative increase of 74.72% (95% CI=54.57; 94.86, P < 0.00001) in daily milk production with domperidone treatment compared to placebo. No maternal or neonatal adverse events were observed in any of the trials.

These findings indicate that domperidone increases inadequate breast milk production in nursing mothers more effectively than placebo. A statistically significant increase in the mean change in daily breast milk volume from baseline was observed in all three studies comparing domperidone and placebo. This consistency of the domperidone effect across the studies enhances the confidence of its beneficial effect as a galactagogue.

Currently available data from a few small randomized controlled trials suggest that domperidone produces greater increase in breast milk supply than that found with placebo in some puerperal women with insufficient milk production. These results, however, should be interpreted in the context of the limitations of available data. Additional randomized clinical trials of adequate sample size are desirable and might have an impact on our confidence in the estimate of domperidone effect as a galactagogue. In the realm of clinical practice, however, while the balance between desirable and undesirable effects often guides treatment decisions, the current analysis supports consideration that domperidone might be an effective treatment option for selected women with inadequate lactation. It appears to be prudent though to try nonpharmacological interventions, for example, maternal lactation education, first.

Source: Hindawi Publishing Corporation Obstetrics and Gynecology International

Volume 2012, Article ID 642893, 7 pages

doi:10.1155/2012/642893