Domperidone plus prozac, wellbutrin, or effexor while breastfeeding?

[Featherblue]

Hi, I'm hoping you can give me some guidance, as I'm feeling very unsure about what to do in my situation. I am taking 120mg/day of Domperidone for milk supply. I have tried to wean off of it twice with major repurcussions on my supply. I will have to continue the Domperidone until I wean from breastfeeding.

I am feeling very low and need to start antidepressants. Prozac has been very helpful for me in the past, but my doctor says it's counterindicated with Domperidone. She will prescribe either Wellbutrin or Effexor while I'm taking the domperidone. I'm trying to make an informed decision about which would be less risky for my 8-wk-old. Can you give me some guidance on not only the antidepressant interaction with domperidone, but the safest choice in my situation? My depression is very much tied up in our breastfeeding issues, so I do not believe stopping the Domperidone will help my depression.

Many thanks

[admin]

Featherblue:

First, I do not suggest doses above 60 mg/day as the risk of arrhythmias increases as does the difficulty of withdrawing off of it. Secondly, I'd suggest you start a long slow withdrawal off of domperidone and see if you can continue to breastfeed at 30-60 mg per day for a while, even if its only a small amount. This may take a month to withdraw, but I'd strongly suggest you do this.

In addition, domperidone has many drug-drug interactions that can dangerously increase the plasma levels of domperidone. Venlafaxine (Effexor) and fluoxetine( Prozac ) are two of these drugs that may elevate domperidone plasma levels. Bupropion (Wellbutrin) is apparently not contraindicated with domperidone and would be a suitable choice.

Lastly, if the domperidone taper doesn't work, then you have to make a decision about what's best for your infant, breastfeeding, or a healthy happy mother. All the time my group has to make decisions in weighing the benefits of breastfeeding against the hazard of untreated disease (depression). The research is quite clear, maternal depression is really bad for an infant.

In your situation, I'd suggest you take care of your depression and if that allows breastfeeding, OK. But if not, then use the antidepressant that works best and breastfeed all you can, even if its not much.

Regardless of how much milk you make, its still wonderful for your infant.

Tom Hale Ph.D.
Infantrisk Center

[Featherblue]

Thank you so much for your reply. I am beginning a long, slow weaning from the domperidone (10mg per week, hoping to be able to keep my supply). In the meantime, is my best choice starting the Wellbutrin? I'm having increased anxiety and panic attacks in addition to the depression, so I need to do something. My baby is 11 weeks old, no history of seizures.

When I get my domperidone dose down to 30-60mg/day, are the ssris still counterindicated, or is it safe to switch to Zoloft or prozac? Or will I need to be completely off the domperidone to change?

Many thanks

[admin-james]

We believe that you can safely start on Zoloft or Prozac with a domperidone dose of 30mg/day. Zoloft is marginally safer for breastfeeding, but Prozac generally works better for anxiety. Your experience may be different. You should continue weaning domperidone down to 0. You should be able to start Wellbutrin now.

-James Abbey, MD