I have some thoughts I’d like to share regarding this Domperidone issue…it
was written:

 

>>…Karin Cadwell & Cindy Maffei.  They were VERY adamant that nobody should
be suggesting domperidone or prescribing it in the US (I'm sure this is a
controversial topic, but I am just passing on what they taught). The FDA is
apparently cracking down pretty hard on it, and considers it a potentially
dangerous drug (and in my medical opinion, it shouldn't be suggested to
anyone lightly).  Compounding pharmacies have received serious warnings
against distributing it.  As an RN presumably without prescribing
privileges, you would be outside your scope of practice.  Even if you
verbally suggest or recommend a medication or even an herbal (e.g.
fenugreek) without writing a physical prescription, a court or licensing
board could find that you were "prescribing" via that recommendation.  Tread
cautiously! >>

 

We have discussed domperidone as well as the FDA issues with the alleged
risks (unfounded) and their threats against compounding pharmacies (if I
remember correctly they have no rights there) in depth here on Lactnet.  It
really bothers me that the actions of the FDA (which I believe have subsided
considerably) and the supposed risks of this medication seem to be being
discussed like it is new news – this is OLD news!   Please correct me if I
am wrong…  And, by the way, there are many compounding pharmacies that still
do compound domperidone AND there are quite a few Drs in my area prescribing
domperidone knowingly and willingly for the purpose of increasing milk
supply – they are doing this in conjunction with the IBCLC’s they work with.
This is a GOOD thing!  Yes, to get it here in the US is considerably more
expensive than to get it from overseas, but it is happening and it IS LEGAL.
Dr’s frequently prescribe medications for other than their intended purpose
– and I am sure that applies even to other meds that are not FDA approved…

 

Domperidone is in fact a safe medication when used for not only its intended
purpose but also when used to increase prolactin levels to assist in milk
production (per Hale and the UK which has it over the counter).  Anecdotal
experience (well over 40 of my own personal clients in the past 10 yrs have
used it with great success and minimal side effects if any) has shown
domperidone to be a safe and effective drug.  The safety of domperidone over
Reglan is widely known and has been discussed here many times.  Check the
archives…  I have had many clients in the past try the Reglan, have horrid
side effects (severe depression, loss of milk supply when they stop taking
the med, severe life threatening allergic reaction, to name a few) and then
switch to domperidone with fabulous results.  Knowing that moms can safely
take domperidone for extended periods of time without harm is a wonderful
thing.  

 

Yes, there are some interesting side effects that are popping up, I even
spoke to Jack Newman about them – but, unlike the side effects of Reglan,
the moms are not concerned and the side-effects are not life threatening (as
severe depression often can be).  What are the side effects of domperidone?
Upset tummy, headache (only one mom I have worked with had these), looser
more frequent stools and weight gain related to mom feeling constantly
hungry – Jack said these made sense to him given the nature of the drug.
Moms will deal with and accept these minor side effects in order to be able
to feed their babies…  And, I’ll tell you what, if I needed a milk supply
and had to choose between the side effects listed above from domperidone
(but knew I could take it long term if needed) and the side effects of
Reglan - I’ll take the domperidone any day.  Having suffered from postpartum
psychosis (yes, you read that right) with baby #1 and PP Depression with
baby #2 that bordered on PP Psychosis – well – you tell me - what you would
do?  Too many women are already at risk for PPD – just given our culture
filled with stress and lack of support, the birthing process itself (we have
also discussed that at great length) and then to have difficulties with
breastfeeding and finding you are not able to make enough milk to simply
feed your child – wow.  Why take the KNOWN risk of taking a medication which
has a main side-effect of depression???  Start with the basics of increasing
the milk supply and work up from there.  Domperidone should not necessarily
be the first choice – but it should be an option that moms are told about
when nothing else is working.  Just my own personal opinion…based on my own
personal research and education.

 

I too would like to know what medical concerns there are re: domperidone…I
just haven’t seen any – not in person with the clients I work with who take
it, nor in the literature when discussing taking it orally.  I am aware of
the risks of IV treatment – this is the basis of the FDA’s claim of
“DANGER!!!” in regards to domperidone – those risks are not there when
domperidone is taken orally and the fact of the matter is, that when taken
orally, the medication reacts differently in the body AND it is taken is
considerably smaller amounts than the persons received 20 yrs ago when they
received it in IV form and had health related issues (death).  And if you
really want to be hardcore about it – every single medication on the planet
has risks (pharmaceutical and herbal) – people die (or have severe
reactions) all the time from meds that their bodies react to (even those
meds that the majority of people do fine with) – so why is the FDA not
banning ALL prescription meds?  Because it wouldn’t be good for
business…and, this may tick off other USA citizens, but the FDA is not the
be-all-end-all authority on medications.  Just because they are in the USA
does not make them smarter or better than any other organization in the
world when it comes to medications.  So, I kind of have to wonder - what
really was the underlying reason for the FDA going after a drug that has
considerably fewer and considerably less severe side effects (domperidone)
than its USA counterpart (Reglan) and why they dug up 20 yr old information
(couldn’t they find anything newer than that?) based on a method of
treatment that isn’t even used anymore in order to make it look so
dangerous?  Hmmm…any ideas anyone?  I have a few.  And, for those of you who
don’t know me – I live here in the US…

 

Re: anyone combining ‘prescribing’ or recommending herbs or meds how can
that be considered prescribing?  Call me naïve but if recommending or
suggesting that others have used these things is considered prescribing then
I guess most of us prescribe all the time.  For goodness sakes, how many of
us (before we got into this field) told a friend to go take some aspirin for
their headache or a decongestant for their stuffy nose?  People “prescribe”
to each other ALL THE TIME.  Try this or that funky remedy for this or that
condition.  Re my professional suggestions for galactogogues, my wording
consists of “Many moms have found “this” to be useful and helpful.  Here are
the pros and cons and here is what the research <Hale, etc.> says about it.
Here is where you can get “it” and please do your own research to make sure
you are comfortable with what you are taking.”  How could this be considered
prescribing?  I suppose that since I am not an RN, nor do I work for anyone
other than myself my limitations and risks are considerably different from
someone who is an RN and who does work in a medical type setting.  

 

Personally, I think common sense plays a part here – also really reading the
research and the literature.  Do your homework – I don’t think anyone should
blindly accept what someone else says as gospel – my personal opinion.  I
tell all my clients to not just blindly accept what I have to say – yes, I
know my stuff and am good at what I do – but it is their responsibility to
do their own research and KNOW what they are doing and why.  If what I say
or suggest makes sense and they are comfortable with it, great – but if not
don’t do it because “I said so” – do it because they did their own research
and learned on their own that what I suggested was, in fact, a good course
of action for them.  Education is an important part of what we do, and we
have to continually educate ourselves and form our own opinions and beliefs
based on the evidence we find.  I may love Jack Newman, but I don’t always
agree with everything he says...so, I do my own research and come to my own
conclusions…sometimes they agree with him, sometimes not.  But hey, I did my
own research and made my own educated opinion…

 

Take care all…just my personal opinions this morning…I know, I know, I have
many of them…. :-)

 

Jaye Simpson, IBCLC, RLC, CLE, CIIM, MOM

(Love all those acronyms!)

 

 

 

 


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