Domperidone withdrawal resulting in insomnia

[Gillian]

Hello Infantrisk team
After a little more than 3 years I’m trying to get off domperidone but the final taper is proving to be very difficult.
I was on 60mg (20mg three times a day) 2.5 years ago. And I had no issue reducing to 30mg daily and now finally in the past two months I’m at 5mg daily (1/4 tablet - so 2.5mg - twice a day).

Thinking I’m at such a low dose without any adverse symptoms I can drop my morning dose and so I went with just my evening dose for two days and two days later I couldn’t sleep at all - all night. My mind was racing and I had immense anxiety from not being able to sleep.

For the following two days I stopped all doses completely and the insomnia was horrible. I wasn’t able to sleep at all.
yesterday I went back on my 2.5mg twice a day and I slept great last night.

I’ve never encountered symptoms when reducing in the past at much higher doses but now suddenly At such a low dose my withdrawals were really bad.

I’m hoping to reduce to 1/8 tablet morning and 1/4 tablet evening in 4 weeks. I just need some time to gain my sleep patterns back. In 6 weeks I plan to reduce to 1/8 tablet twice a day. I’m afraid to stop it completely after that and it’ll be hard to cut the already very small pills any further than 1/8. Is there any advice?

thank you
Gillian

[admin]

Hi Gillian,

It seems like we've been hearing these reports more and more. An increase in milk production is a side effect of domperidone--it acts on dopamine receptors similar to antipsychotics. 2.5 years is a long time for your brain to get used to the medication, and your body will take time to adjust to getting off of it.

I've heard quite a few stories of moms having trouble getting off the last bit of domperidone. Stick with the slow, graduated titration like you are doing (it is called a hyperbolic dose reduction, or hyperbolic taper). The best advice I can give is to be as gentle as your body needs--be patient. Try not to reduce doses at intervals less than a week or even two.

As for how to handle the very small amounts, your options depend on where you live. In Canada or other countries where domperidone can be prescribed, a compounding pharmacy can prepare a formulation that is easier to manage. If you are in the US, your options are trickier. Reach out to a local compounding pharmacy and see if they will help you. That is the safest option to ensure you can get the small doses you will need.

Keep an eye on the InfantRisk website and social media in the next few months. We've been doing some work on the complications of domperidone.

Best,
Dr. Kaytlin Krutsch, PharmD

[Gillian]

Thank you for your advice. I’m in the U.S. and reached out to a compounding pharmacy and they are unable to do so unfortunately stating the following:


“The U.S. Food and Drug Administration (FDA) issued an import alert in 2004, updated in 2012, explaining that the importation of domperidone is illegal with limited exceptions, including when imported pursuant to an investigational new drug application. The FDA also issued a public safety warning regarding the use of domperidone for lactation.”

I will see how it goes with a precise pill splitter to further split the 1/4 tablet and reduce doses very slowly.

Thank you again for your response.

G

[admin]

I was afraid of that. You may see if you can get a Canadian compounding pharmacy to help. You may also check with local independent pharmacies who may not be able to prepare the formulation for you, but may be willing to help you devise a plan.