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Domperidone in the US

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  • Domperidone in the US

    I am a fairly new lactation consultant (became an IBCLC last year)....I have come across a mom whom I think could benefit from domperidone....after trying all other ideas and persistent low milk supply....she brought this up to me to take domperidone but I am clueless about whether I should recommend it or how to help her get what she needs. I've read it can only be from a compounding pharmacist...and if so, how do I go about getting a doc to write a script and/or a pharmacist to fill it....not to mention getting it paid for by insurance. Also, will I "lose my IBCLC license" if I even suggest or encourage her to take this (assuming she can even get it in the US). I'm just confused about the "illegal vs. off label vs orphan drug status" propoganda about domperidone in the US. I want to help this mom but I don't want to get in trouble.....

  • #2
    Cara:

    True, you do need a prescription for this medication and many physicians are willing to provide one, once they see and evaluate the patient. This is their job to make this decision.

    My suggestions on determining if a mom needs domperidone is to simply do a prolactin level. Have the mom breastfeed, wait 2 hours and draw a blood sample. If the prolactin level is below 10 to 50 ng/mL, then she is probably hypoprolactinemic for a breastfeeding mother, and Reglan or Domperidone would probably work efficiently.

    Normal prolactin levels for a fully breastfeeding mothers need to be above 70 or so at 6 months, and above 100 or so at 1-3 months. Ten mg TID of Reglan will increase it to over 125 ng/mL. 10-20 mg of Domperidone will do likewise.


    Tom Hale Ph.D.
    Professor
    TTUHSC

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    • #3
      How/where would she obtain Domperidone in the US? I've heard that even some compounding pharmacies do not give it for that diagnosis (hypoprolactinemia) and if they do, that it costs a pretty penny and not covered by insurance. Just curious if she does get her Dr. to write the prescription, where she would get it filled? Thanks for your time and consideration....I know you are a very busy.

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      • #4
        Cara:

        Get on the phone and call your local pharmacies, particularly compounding pharmacies and ask them if they compound domperidone. And forget about getting an insurance company to pay for it, they won't.

        tom

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        • #5
          Ok...so this mom got 2 scripts...one for Reglan (which she has been taking for 3 weeks) and one for domperidone (which she would like to order online soon. My question now is that she hasn't seen a huge increase in milk supply on the reglan. Should she even bother with domperidone? I talked with your Infant Risk reps on the phone and she said it wouldn't likely help if Reglan didn't but the mom should have her prolactin levels checked. I am not sure our lab (small town hospital) can even draw a prolactin level but maybe her OB in the bigger city can. Also not sure she will want to go to tall the work of getting lab drawn at this point. I just wanted to verify that reglan and domperidone would likely increase milk supply in the same way and that I'm not missing something before I tell her not to bother with the domperidone at this point. Thanks in advance for your help.

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          • #6
            Dear cara413,

            Reglan and domperidone work by increasing prolactin levels. My thought is this mother's prolactin level is probably normal to high since the Reglan did not increase her milk supply. These drugs would only work if her prolactin level was low. She can certainly have a prolactin level drawn to verify this. It doesn't appear that trying domperidone would help her at this point.

            Sincerely,
            Cindy Pride, MSN, CPNP
            TTUHSC InfantRisk Center

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            • #7
              Hello,
              What is considered a high level of prolactin level?

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              • #8
                Dear garciazi,

                Prolactin levels above 70 ng/ml are usually considered high from a lactation standpoint.

                Sincerely,
                Cindy Pride, MSN, CPNP
                TTUHSC InfantRisk Center

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                • #9
                  weaning off reglan??

                  I know you are supposed to wean off reglan gradually but I am not finding info on exactly how to tell this mom to wean off Reglan...She has been taking it for 3 weeks. Let me know how to direct her. Thank you again.

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                  • #10
                    Cara:

                    We generally suggest weaning down 10 mg per day per week. So if you are taking 30 mg per day, drop it to 20 mg per day, then one week later drop to 10 mg per day for the next week. But this all depends on the mothers response.

                    Tom Hale Ph.D.

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