Domperidone, sold under the trade name Motilium, is an anti-emetic and domaminergic blocking agent. It is not FDA approved for use in the United States, although it is prescribed in Canada and several other countries. Worldwide, domperidone is primarily used in the treatment of bowel disorders and to prevent nausea and vomiting caused by medications used to treat Parkinson's disease. In the United States, it is most frequently used to increase breast milk supply in nursing mothers.
Domperidone works by increasing stomach and bowel contractions, easing the passage of digested food through the body. It also decreases nausea and vomiting and increases the production of prolactin, a hormone produced by the pituitary gland. Prolactin increases the production of breast milk, and if present in high enough levels, can cause women to lactate even if they have not recently given birth. Because very little domperidone crosses the blood-brain barrier, it has fewer side effects than other drugs used to increase milk supply in nursing mothers.
Most people who take domperidone do not experience side effects, and when side effects occur they are usually quite mild and do not require the discontinuation of the drug. The most common side effects associated with domperidone include headache, abdominal cramps, dry mouth, altered menstrual cycles and increased production of breast milk. Women who are not lactating may experience breast swelling and discharge from the nipples.
Rarely, domperidone causes side effects that may indicate a serious problem. The following side effects should be promptly reported to a doctor: loss of muscle control or balance, fast or irregular heartbeat, and swelling of the face, hands, legs, feet or mouth. Domperidone has been known to provoke cardiac problems, but this has only occurred in people who were quite ill and receiving the medication through an IV line in a hospital.
The use of domperidone to enhance lactation in breastfeeding mothers is controversial. Some experts have recommended its use for this purpose, including Jack Newman, M.D., a paediatrician who specialises in problems related to breastfeeding, and Thomas Hale, Ph.D., a professor of paediatrics at Texas Tech University School of Medicine and author of "Medications and Mother's Milk." For a time, the American Academy of Pediatrics also endorsed the use of domperidone to increase breast milk supply. However, the FDA issued a warning against the use of domperidone in breastfeeding mothers in 2004, citing the potential for serious side effects and a lack of research on how the drug might affect infants.
The legal status of domperidone in the United States is complex. The drug may be legally imported by a physician who wishes to prescribe the drug to patients with severe gastrointestinal disorders, although there is significant red tape involved in this process. Women who wish to take domperidone to increase their breast milk supply may order it from an international pharmacy, but in this case they face the risk of the package being seized by the FDA. In 2006, a federal court ruled that compounding pharmacies in the United States could fill prescriptions for domperidone and other medications that are not approved by the FDA. However, there are very few compounding pharmacies that have this drug in stock, and further imports are subject to seizure.