Having calmed down somewhat, I now present a more formal review of the Domperidone article:



Review


Use of Domperidone as a Galactagogue Drug: A
Systematic Review of the Benefit-Risk Ratio


Journal of Human Lactation: 2015, 3(1): 57-63


The article is not a systematic review of the
benefit-risk ratio. Not all of the relevant literature was reviewed. Only one
paragraph is devoted to the “worrisome” drug-induced long QT syndrome.  The patient population, which is vastly
different than a breastfeeding population, is not even defined by the authors.
The different routes of administration between the two different populations is
not addressed either.


The authors conclude that there “is still lacking
scientific basis” for the indication of domperidone as a galactagogue.  The data submitted to obtain Orphan Drug
Status for domperidone for insufficient milk supply refutes that conclusion.


The conclusion that domperidone is compatible with
breastfeeding is “nuanced” by the “small number of patients included and the
short and disparate duration of treatment (4 days to 6 weeks).” Once again,
data submitted for Orphan Drug status refutes that conclusion as does the use
of domperidone for decades.  Six weeks is
not even sufficient for the authors to conclude that domperidone is compatible
with breastfeeding. 


Finally,
the authors conclude that “an improvement of breastfeeding practice seems to be
more effective and safer than the use of an off-label domperidone
treatment.”  This conclusion “seems” to
solidify my opinion that the authors know little or nothing about Lactation
Consultants and their practice, about the use of domperidone in the
breastfeeding community, the “A
Consensus Statement on the Use of Domperidone To Support Lactation”, how to
conduct a  true benefit-ratio for drug
use in breastfeeding women, the current status of domperidone world-wide, and
most importantly, how to properly conduct such a review. 
As a pharmacist, I am frustrated by the fact that four of the authors are
pharmacists who evidently are not breastfeeding knowledgeable.  I am saddened that the Journal of Human
Lactation and ILCA reviewers approved this review for publication with its
improper conclusions, especially as a FastTrack Review. This has resulted in a
disservice to Lactation Consultants and to the mothers and children who benefit
from proper counseling on the use of domperidone. Once again, if you have not, please check out my Domperidone Handout on
my website: www.nicebreastfeeding.com under
“Counseling Tips.”







Frank J. Nice, RPh, DPA, CPHP



 		 	   		  
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