Domperidone not effective anymore

[Gillian]

I've been on domperidone (60 mg/day) for 18+ months and my supply did great on it, but now my supply has gone down. If I reduce the domperidone to 30mg, 20mg,10 mg and then 0mg over four days and then start on the 5th day at the 20mg TID. In 3-4 days my supply peaks and increases again by 6-8 oz total. But then it creeps back low again by the third week.
In the past adding goats rue and fenugreek to the domperidone made my supply sky rocket but now it has the opposite effect of lowering my supply.

What is the reasoning behind this and should I reduce for longer before going back on domperidone to increase my supply to what it was before?

Ive tried the 90mg a day dose and I see an increase for two weeks before it reduces back down to low.

Will taking domperidone 20mg QID be more beneficial than TID? Ive read that the half life of domperidone is about 7 hours so would taking it every 6 hours rather than every 8 hours be able tp bring back the ample supply I was having 6 months ago?

[admin]

Gillian:

Its natures way to reduce the milk supply after about 12 months, so I'm not sure you can keep or build up your supply forever. The breast simply starts to involute after a year, lactocytes start to die off (called apoptosis), and the milk supply starts to wane.

Further, I would be careful using high doses of domperidone, as some women develop a horrible dependence and miserable withdrawal from domperidone AFTER using high doses (> 60 mg/day).

Technically, domperidone does not stimulate milk synthesis, all domperidone does is to stimulate your prolactin levels, which then stimulate milk synthesis.

You could have your physician check your prolactin at 1 hour AFTER feeding, and if it is > 100 ng/mL then that is ALL you can hope for, and if this level is not stimulating milk production, nothing will.

Remember, domperidone stimulates myocardial arrhythmias in SOME patients, so be careful with this med at high doses.

Tom Hale Ph.D.

[Gillian]

Thank you Dr Hale that’s a very sound reasoning.

Until I taper and wean off the medication. Is there a particular method to minimize the amount of domperidone for the child that will be ingested via breastmilk ? I understand the half life is 7.5hours.

I’ve read the study that measured the amount of domperidone in breastmilk 3 hours after a dose. (Excerpt below). Does it likely peak at 3hours after a dose since that’s when they measured it ?

Is there any data on what is the milk concentration peak time for domperidone? So I may lessen the exposure of the medication for my child.

Gillian

..........
”A double-blind, controlled trial compared two dosages of domperidone for increasing milk supply in mothers of preterm infants. Mothers received either 10 mg or 20 mg three times daily. Drug concentrations in breastmilk were measured once between days 10 and 15 three hours after a dose. Milk domperidone concentrations were 3.4 mcg/L with the 10 mg dose (n = 4) and 6.9 mcg/L with the 20 mg dose (n = 3).[12 ([url]https://www.ncbi.nlm.nih.gov/books/NBK501371/#LM495.REF.12)]”[/url]

[admin]

Gillian:

It peaks in the milk at the same time it peaks in blood, and thats about 30 min to1 hour after ingestion. But its so low, and its oral bioavailability is only about 15%. So no real risk to the infant at all.

Tom Hale