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  • Domperidone dose

    Hello
    I recently attended a conference where Dr. Hale was a speaker. Dr. Hale spoke about optimal dosage for Domperidone. In our area, we often start a mother on 20 mg QID (as per Jack Newman guidelines). Dr Hale had explained that due to the pharmacokinetics, beyond a certain dose there would be very little advantage. Its silly, but I can't remember if he said that at 10 mg TID or 20 mg TID that 80% percent of the effect would have been achieved, with little advantage of a higher dose. Would you be able to clarify?
    Many thanks

  • #2
    Meggie:

    At least two studies now confirm that 20 TID produces maximum prolactin levels, and "slightly" more milk than the 10 mg TID dosage.

    I'd suggest starting with 10 mg TID, and then increasing to 20 mg TID if necessary.

    We do not have data that doses greater than 20 mg TID, produce 1) more prolactin, or more milk. It may, we just do not know this for sure. My guess, that the effect of domperidone on the pituitary lactotrophs maximizes at 20 mg TID.

    We do know that at this dose, the prolactin "surge" stops occurring after 10 or 20 mg TID and prolactin levels become flat or static at much higher levels. This suggests that the pituitary lactotrophs no longer 'store' prolactin, but only create and release all that is synthesized continually, thus leading to a much higher static level of prolactin in the moms plasma.



    Tom Hale Ph.D.

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    • #3
      Excuse my ignorance but am not familiar in Australia with "TID". Is this three times daily?

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      • #4
        Linray54:

        Yes, TID is three times daily. Sorry.

        Tom Hale

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        • #5
          Dr. Hale can you provide me with the details of the two studies that state 20 mgs three times daily is the optimum dose. I have informed my NUM of this information but she requires the two studies to get the obstetricians to change to this dose. At the moment women are given 30 mgs three times daily and if this is not needed why do it??

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          • #6
            Dear Linray54,

            The two studies that discuss the dose effects of domperidone are as follows: Hofmeyr GJ, van Iddekinge B, Blott JA. Domperidone: secretion in breast milk and effect on puerperal prolactin levels. Br J Obstet Gynaecol 1985; 92(2):141-144, and Wan E W-X, Davey K, Page-Sharp M, Hartmann PE, Simmer K, Ilett KF. Dose-effect study of domperidone as a galactagogue in preterm mothers with insufficient milk supply, and its transfer into milk. British Journal of Clinical Pharmacology 2008; 66(2):283-289. From these studies, it appears the higher dose of domperidone didn't statistically increase prolactin levels compared with the lower dose; therefore, increasing the dose doesn't appear to be helpful in increasing prolactin levels. There were also increased side effects for the mothers who took the higher doses. These doses are from published studies, and no conclusions on the appropriate dose of domperidone have been located. Dr. Hale states that the lowest effective dose should be used, and his conclusion from the published studies is the dose appears to be 10 mg to 20 mg three times per day. Hope this information helps.

            Sincerely,
            Cindy Pride, MSN, CPNP
            TTUHSC InfantRisk Center
            Last edited by cpride; 03-20-2012, 03:01 PM.

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            • #7
              Many thanks Cindy for replying to my question. I will now pass this information on to my NUM and she can take the appropriate steps to make sure we lower our dosage. Linda

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