Domperidone generic brands- will they act the same?

[nomidee]

Hi Dr Hale
I have a question regarding two "generic" brands of domperidone 10mg that are manufactured in India and sold through the internet company inhousepharmacy.biz
Domperon 10mg by Cadilla - this is actually sublingual
Vomistop 10mg by Cipla
I am hoping to sit the exam to become an IBCLC this year and in my studies I found that different brands may not be bioequivalent due to their excipients, even though I always thought generic drugs were exactly the same (that's what the pharmacy tells me when I buy my medications!). I'm a little concerned because many mothers in the US and possibly my own country, Australia, have turned to these brands as they are cheaper than Jannsen's Motilium. I have emailed the companies to find out what their excipients are and if it is bioequivalent to Motilium but haven't heard back from them *surprise surprise*
Do you have any way to find out whether mothers may be taking something that is not effective, or as effective as Motilium?
Would the sublingual one, Domperon, have a different effect if mothers are swallowing whole with a glass of water, as some are?
Finally, I myself had to take Domperidone for both my babies due to my own insufficient glandular tissue (or hypoplastic breasts). I had differing advice from pharmacists as to whether I had to follow the domperidone instructions on taking 30 min before meals, or if it didn't matter if I wasn't taking it for the gastrointestinal effect. What is your recommendation?
I would really appreciate your advice on this.
Thankyou for all your hard work in the field of breastfeeding medicine!
Naomi

[admin]

Nomidee:

There is no way to know for sure if any generic product is bioequivalent to the trade name product, short of doing bioequivalency studies. And I'm sure the various generic companies are not too interested in doing these. So I can't tell you if the generic product are equivalent to the Motillium brand.

As for the sublingual product, the absorption of these is probably higher if used sublingually, since it bypasses all the intestinal and liver metabolism. Plasma levels "may" be higher if they are NOT swallowed, but held sublingually. I do not know this for sure, as I haven't seen any studies of the sublingual product.

As for dosing, I do not recommend high doses, as there is no evidence that 90-120 mg per day works any better than 60 mg per day (and these high doses are known to be more hazardous). I suggest the 10-20 mg three times daily dose. As for when to take it, it is known that domperidone is better absorbed with a meal.

Tom Hale Ph.D.