Hi Brenda-


Thanks for posing your question! I can only answer for myself :) 
I'll add the disclaimer that I took domperidone for 9 months and that I had very good success with it.


I have prescribed it both as part of the Newman-Goldfarb protocol and for postpartum lactation management. 
I do think that the cardiac warnings and the lack of FDA approval in the US present a few hurdles for prescribers, though they're not insurmountable.


First, I will say that I will only prescribe dom under specific circumstances, either as part of a protocol for induced lactation or as an adjunct to other steps to improve/maintain supply.


When a patient comes in for a ppv or calls the nurse line requesting meds for low supply, I talk with her in general terms about "normal" feeding patterns and indicators of adequate intake. (I do this myself because if my office staff handles it they invariably leave out important questions!)  I encourage any patient who still believes that she has low supply to discuss her concerns with an IBCLC. I am not qualified to make a thorough assessment in latch, etc. Once she has seen an IBCLC and the IBCLC agrees that domperidone may be a useful component in a plan to boost supply (or states that the assessment is good and that the mom is doing all the "right" things), I see the patient in the office to discuss the risks, benefits, and alternatives. I provide some written information on the fda/off-label/compounding aspect and discuss the cardiac warnings. We specifically discuss family cardiac history and any meds that may have cardiac implications. Although I have offered a baseline EKG in the past, I am considering requiring it now in light of the new statement. 


My local compounding pharmacies will not fill it unless a physician signs a statement indicating it is for gastroparesis. Consequently, we have had patients order it from a pharmacy about 2 hours away. 


I know the other physicians in my practice don't require all the steps that I do. I don't do it to be unnecessarily burdensome- I just believe that anyone who is looking for a galactagogue really deserves a full assessment. 


Hope that helps.


Feel free to email me off list if needed.


Elizabeth Boggs, MD
Women Physician Associates
9 Med Park Ste 620
Columbia SC 29203

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