Domperidone Safety Checklist

BackgroundDomperidone(orMotilium)isamedicationthatcanbeusedtohelpwomenimprovetheirmilksupply.Ithasbeenshowntobeeffectiveandsafe.Theusualdosageis10mgtdsorally.Ifthisisnoteffectivethedosecanbeincreasedto20mgtds.Lowmilksupplymaybesuggestedby:

• InadequatebabyweightgainORexcessiveweightloss(>10%frombirthweight).• Thehealthytermbabyhasnotregainedbirthweightby2-3weeksofage.• ThebabyisfallingacrosspredictedweightpercentilesontheWHOgrowthchart.• Thereisinadequateurineproductionand/orinfrequentstools.• Theinfantisunsettled(andthoughttobefrompoorsatiety).

Lowmilksupplymustfirstbeaddressedbyimprovingbreastfeedingby:

• Ensuringappropriatefitandholdwhilebreastfeeding.Thisallowsgoodmilktransfer,comfortablefeeding,andpositionalstabilityforthebaby.PleaseseetheGestaltBreastfeedingOnlineProgramforhelpwiththis.https://education.possumsonline.com/programs/gestalt-breastfeeding-online-program

• Frequentfeeding.Mostbabieswillneedtofeed8-12timesin24hours.Ifthereislowsupply,feeding12timesadayisoptimal.

• Considerationofextrastimulationbyusingabreastpumpafter(someorall)feeds.MOTHER’SNAME:MOTHER’SDOB:ChecklistBeforePrescribing1.Knownhypersensitivitytodomperidone;renal/hepaticimpairment;orhistoryofprolactinoma?Domperidoneiscontraindicated2.Knowncardiovasculardisordersorfamilyhistoryofarrhythmias/suddendeath?Domperidoneiscontraindicatedinpatientswithahistoryofcardiacabnormalities,especiallyarrhythmias.Ifconcerns,performECGpriortocommencingdomperidonetoassessQTinterval.3.KnownuseofmedicationsthatcanprolongQTintervalORinhibitCYP3A4(ieSSRIs,oralfluconazole,“-mycin”antibiotics,ondansetron)?Domperidoneisarelativecontraindication.Ifdomperidonestronglyindicated,suggestanECGpriortoprescribingtoassessQTintervalaswellasanother3daysaftercommencing.CeaseifQTisprolonged.4.Advisethepatientofpotentialsideeffects:drymouth,transientskinrash,itching,headache,thirst,abdominalcramps,drowsiness.Mostaremildandrarelyresultinceasingmedication.5.Advisethepatienttoseekimmediatemedicalattentioniftheyexperiencedizziness,palpitationsorseizures.