Research on domperidone

I thought I’d write this post in case someone else is taking domperidone for breastfeeding, and have concerns about the safety of the drug.

I was spending some time this week doing research on Domperidone, the prescription drug that helps me produce more milk to breastfeed my baby.  Dr. Livingstone at the Vancouver Breastfeeding Centre is dead set against the drug.  My own doctor is a bit on the fence.  And my public health nurse thinks I should just keep taking it if it is helping me breastfeed.  With all the conflicting advice, basically I need to make up my own mind about it.

If you were to do any research on breastfeeding, Dr. Jack Newman is a name that will come up everywhere.  He has a lot of very useful information and videos on his website about breastfeeding.  He is the authority in this area.  I would certainly consider whatever he has to say about the drug.  When Health Canada issued the black box warning about the drug, Dr. Newman issued the following statement:

Based on a study that was published in Belgium which looked at over 1000 cases of sudden death and found that some of the people who died suddenly were taking domperidone, Health Canada has put out a warning about possible concerns about treating with domperidone. This is a bit of an overreaction on the part of Health Canada. Well, a big overreaction given the data.

Note that in the study, the youngest person who died was 55 and the average age of those who died was 75 years. What has this to do with breastfeeding mothers who are rarely older than 45 years and are usually in reasonably good health? Furthermore, this information came from a data base with no clinical information. It simply has information that so and so died  suddenly and was taking such and such a drug. The thing is that domperidone in these patients was used for reflux and we know that heart disease is frequently misdiagnosed as reflux; severe pain at the top of the abdomen or lower part of the chest is typical of both reflux and cardiac pain.

Misdiagnosis is particularly possible in Europe where domperidone is available in countries like the United Kingdom, Belgium and the Netherlands without a prescription and it is likely that many people are self-diagnosing and self-medicating.

So that’s it and it does not mean that domperidone kills. I will continue to prescribe domperidone at our doses which are based on many years of clinical experience. I have treated many thousands of women with it with only minor side effects. I believe this article from Belgium proves nothing and does not require us to stop prescribing it.

It would be a pity that mothers and babies not benefit from domperidone when used in conjunction with our Protocol to manage breastmilk intake.

Dr. Newman is also a part of the consensus statement issued by a number of breastfeeding doctors.  It is a very good read, giving a lot more information on the articles/studies that Health Canada based its warning on.

I know Health Canada has to issue these warnings when there is a possibility that a drug could have harmful effects.  But it would seem to me that it has over reacted here, especially the statistics came with no clinical information.  I have yet to find any articles or research on the harmful effects of the drug, other than potentially giving you an upset stomach.

I still haven’t decided if I am going to decrease the domperidone dosage and track Savanna’s formula intake, based on Dr. Livingstone’s advice.  But either way, at least I feel more at ease about taking the drug if I need it.

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