5 things your LC wants you to know about Domperidone

If you’re reading this, there’s a good chance milk supply has you stressed and someone has mentioned domperidone. I work with families in this spot every week. Domperidone can help the right person at the right time - but it’s not a shortcut, and it’s not for everyone. My goal here is to share what every parent should know before considering it, so you can make an informed, safe decision for both you and your baby.

1. It’s not a magic pill

Domperidone can raise prolactin, and for some parents that translates into more milk. But if your supply dropped because of something else, a medication won’t fix that by itself.

Before anyone starts Domperidone, I want to rule out the common culprits:

• Latch and transfer: is baby actually removing milk efficiently? A shallow latch, oral tension, or a tongue tie can quietly sabotage output. Get a skilled latch assessment in person or virtually!

• Frequency and emptiness: milk supply is demand-driven. Long stretches without feeding or pumping or consistently leaving milk behind in the breast, signals your body to make less.

• Pumping variables: flange fit, pump quality, suction patterns, pump replacement parts and session length matter more than most people think.

• Parent factors: Yes - sometimes it’s hormonal (thyroid, insulin resistance, postpartum shifts) - and we need to address this BEFORE starting Domperidone. And sometimes it’s IGT (insufficient glandular tissue) - where Domperidone is often a better fit, but we still dial in the other pieces so you get the most benefit!

Bottom line: if we don’t address the “why,” we end up medicating around a solvable problem or we set expectations that any medication would struggle to meet.

2. Not everyone can (or should) take it

Domperidone isn’t FDA-approved in the U.S. (it is used in other countries). That alone makes many clinicians understandably cautious. On top of that, medications in this class can prolong the QT interval in susceptible hearts. That does not make domperidone “inherently dangerous,” but it does make safety screening non-negotiable.

If you have any history of heart rhythm issues, structural heart disease, fainting, unexplained dizziness, or you’re on other QT-prolonging meds (certain antibiotics/antifungals and a few psych meds, for example), loop in your cardiologist. Ask about an EKG baseline and whether your other meds interact.

And if your primary or OB isn’t comfortable because it’s not FDA-approved: I encourage patients to frame the conversation as risk reduction, not permission. You’re not asking them to “bless” a decision; you’re asking for help confirming your particular body can use it safely (labs, EKG, drug–drug interactions, monitoring). That’s good medicine.

3. Start slow. End slow.

Domperidone works by lowering dopamine so prolactin (and often oxytocin) can rise. Useful for milk. But dopamine also affects blood pressure, mood, and how “revved” or “flat” you feel. That’s why the pace of changes matters.

Why slow helps:

• Going up too fast can trigger headaches or migraines, dizziness, lightheadedness, or that “woozy” low-blood-pressure feeling.

• Coming off too fast can swing mood the other direction: anxiety, irritability, low mood. Your nervous system likes gentle changes!

  
  

What I see as good practice:

• Titrate up gradually. Think in steps, not leaps. Give your body several days at each step, watch for side effects, and only then consider moving up (with your prescriber’s plan).

  
  

• Hydration + electrolytes matter. Because domperidone can nudge blood pressure down for some, adequate fluids and sodium help maintain circulating volume. Plain water alone sometimes isn’t enough. An electrolyte mix (Liquid I.V.-type, or a lower-sugar alternative) can help you feel steadier, especially in hot weather or if you’re pumping often. If you have hypertension, preeclampsia history, or a medical reason to limit sodium, check with your clinician for a personalized plan.

  
  

• Taper off slowly. The goal is to let dopamine normalize without shocking your system. Your prescriber should outline a taper that eases you down over days to weeks, not overnight.

4. Finding the Right Dose (Not the Highest One)

Here’s the truth I share with every family: domperidone dosing is personal. The “best” dose isn’t the highest one, it’s the smallest dose that actually gives you results with side effects you can live with. That sweet spot looks different from person to person, because our bodies, histories, and hormone patterns aren’t the same.

Domperidone doesn’t work like a light switch. Even once you reach your right dose, the body usually needs 3 to 4 weeks at that steady level to show its full effect. Some people notice little nudges sooner, a bit more fullness, an easier letdown, a few extra ounces in 7–10 days, but the meaningful change often shows up after your system has had time to respond.

When I say dosing is personal, I mean it: I’ve seen one parent do well on something as modest as two tablets three times a day, and another do well on three tablets four times a day. Those are real-world examples under clinician supervision, not recommendations for you. Your tablet strength, other medications, medical history, and response all matter. Work with a clinician who knows your background, can screen for risks, and can help you find your lowest effective dose - and then give your body the time it needs to respond

5. Sourcing Domperidone safely takes real thought!

This is the question I get the most, and I’m going to be very candid:

• Fastest (and generally safest) route: get a prescription from a U.S. clinician who knows your history and will monitor you, then fill through a licensed Canadian pharmacy. Many families use Mark’s Marine Pharmacy because they’re transparent and responsive. This route tends to be more expensive, but you’re working with a regulated pharmacy that will verify dose/lot and store product correctly.

• Budget-friendlier route: some families order from In House Pharmacy. It's cheaper (rates I hear are often around $40/month for generic Vomistop) but slower (plan on 4–6 weeks). If you go this way, be extra careful about your medical screening and follow-up.

• What I don’t recommend: buying loose pills or so-called “razors” from random sellers or forums. You have no control over manufacturing standards, storage, or tampering. That’s your body and your baby, we don’t gamble with either.

• Border option: If you live close to Mexico or Canada, some families obtain Domperidone there. Please verify you’re getting sealed, labeled product from a legitimate pharmacy, and keep your own clinician in the loop for monitoring.

  
  

I don’t receive commissions from any pharmacy, and I can’t validate any vendor for you. Whatever path you choose, prioritize legitimacy, labeling, lot numbers, and a clinician who will monitor you.

A few practical truths that make the biggest difference

Consider these your “make-it-work” anchors (medication or not):

• Protect the signals. Feed or pump frequently enough for your situation, and make sure milk is actually leaving the breast. Small, consistent changes matter!

• Fix the fit. If you pump, get sized for flanges; if you nurse, get eyes on latch and baby's oral function.

• Track real-world results. Watch diapers, weight, and your baby’s behavior at the breast/bottle, not just ounces on the pump.

• Build your team. An LC for feeding mechanics, your OB/primary for labs and meds, and, when needed, bodywork (PT/OT/OT-feeding, cranio-sacral) and pediatric dental/ENT evaluation for oral restrictions.

My promise to you:

I will never push a medication as a cure-all, and I’ll never shame you for wanting to try one. My job is to help you make informed, safe, and doable choices that respect your body and your baby. If domperidone is part of your plan, we’ll use it on purpose: after we’ve addressed the basics, with proper medical screening from your provider and a clear exit strategy.

This article is for education only and isn’t medical advice. If you’re considering Domperidone, talk with a clinician who knows your history (and ideally your EKG), and work with an IBCLC who will make sure the feeding plan around it sets you up to actually see the benefit.

You don’t have to figure this out alone. If you need a hand, me and my team are all here for you! - Karolina