For the query on Motilium (domperidone):

Domperidone is an upper gastrointestinal motility modifier.  It acts as a
peripheral dopamine antagonist structurally related to the butyrophenones
with antiemetic and gastroprokinetic properties.

The "peripheral" part is important as this means that it does not cross the
blood brain barrier in significant amounts resulting in less CNS side
effects compared to Reglan (metoclopramide).  This is especially important
for the baby receiving the drug in the mother's milk.  The American Academy
of Pediatrics (1) lists metoclopramide as a "drug whose effect on nursing
infants is unknown but may be of concern" because of its action as a
dopamine blocking agent.

Domperidone works by increasing prolactin levels.  Unlike metoclopramide it
does not affect circulating aldosterone levels.  The increased prolactin
levels persist even during chronic treatment.

The increased prolactin levels account for some of the side effects of this
medication including gynaecomastia, galactorrhea, amenorrhea and impotence.

I use it as a last resort and only when all the other issues of milk
production and transfer have been addressed.  eg.  I had a mother whose baby
was 32 weeks old and in the NICU with necrotizing enterolcolitis.  We do not
have a milk bank and really needed more milk than the mother was producing
by expressing and pumping.

How effective is it? It depends.  It works best if you have a mother whose
pituitary is functioning poorly. Check for a history of Sheehan's syndrome
(pituitary damage associated with significant post partum blood loss),
significant head injury or brain surgery in the past or a history of
infertility and so on.

I tend to use domperidone short term and in a dosage of 10 mg po three to
four times per day.

Summary:  a better drug than domperidone but not a panacea.

From the frozen North,

Shirley

(1)  AAP.  The Transfer of drugs and other chemicals into human milk.
Pediatrics 1994; 93(1):137-150
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M. Shirley Gross M.D.,C.M., C.C.F.P., I.B.C.L.C.
Director, Edmonton Breastfeeding Clinic
Edmonton, Alberta, Canada
E mail at  <  [log in to unmask]  >
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