Domperidone with infant renal disease

[GenRN]

Hi Dr. Hale and Staff,

I have a 25 year old with a 10 month old son with chronic kidney disease. The mother has had to go back to work and has starting pumping to maintain her supply in addition to nursing in the morning and night. Unfortunately, her supply has drastically decreased despite galactalogues like oatmeal, flax, brewers yeast and Mothers Milk Plus supplement. In addition to considering a hospital grade pump rental, she is considering taking Domperidone to increase her supply, as she isn't coming close to keeping up with her son.

Her concern is her son's renal disease. She knows that Dom passes into breastmilk, so she's concerned that he shouldn't be exposed. If she asks the nephrologist, he just looks up the FDA info, sees it's not approved in the states and says no.

G has chronic kidney disease due to posterior urethral valves. He had severe pyelectasis and hydroureteur bilaterally prenatally and was diagnosed with PUV at 8d/o. He had a successful valve ablation at 9d/o. He still has severe/moderate pyelectasis (R kidney is worse), with normal kidney function, though he won't be tested again until 12m. He cannot have any NSAIDS and she was advised to discontinue breastfeeding if she started taking antidepressants again (she has a history of depression).

She would sincerely like Dr. Hale's opinion on the safety of her taking Domperidone in this situation.

Thank you so much for your help in this matter.

[admin]

GenRN:

This is a tricky one. First, domperidone is primarily metabolized in the gut wall, and only partially metabolized by the Liver. Only a small amount (about 10%) is eliminated renally. But the risk here is that it "might" over time buildup in the infants plasma and could cause toxicity. While I think this is remote, its still a possibility.

It sounds like this infants kidney problems are primarily due to the valvular problem, not a glomerular problem. Thus, I would bet that the renal excretion of domperidone would be lessened but not totally blocked.

Should this mom decide to try domperidone, please do not exceed the 10 mg TID dosing. Its all that is necessary, and more would risk higher milk levels. There is no way this mom could check her infant's plasma levels for domperidone, as no one here does this. However, she could follow his gastric symptoms closely for diarrhea and cramping, and follow his ECG.

I'm not sure at 10 months of age, this is really worth the risk. But this is a decision for the mom.

Tom Hale PhD.

[tom1989]

I'm sorry to hear that. My suggestion is that you should let her to take their children go to a hospital making an expert consultation, invited has rich clinical experience of kidney failure, cancer experts, kidney disease expert, and even traditional Chinese medicine. Only to determine the specific condition, the doctor to targeted therapy, so that they will only be restored to health earlier.