Website Flash and Short UKDILAS Statement

Website flash and short UKDILAS statement

Following a review by the EMA/MHRA due to the risk of cardiac adverse effects. advice on the use of domperidone has been updated [Link]. The use of domperidone to enhance lactation is not specifically covered by the review as it is an unlicensed (off-label) indication. However, the recommendations from the review should apply to its use as a galactagogue. As there are limited alternative options for the stimulation of lactation, the use of domperidone can be considered provided non-pharmacological options have been unsuccessful. A maternal dose of 30mg daily for a maximum of 1 week should not be exceeded. Domperidone should not be used if the mother or infant:  Have conditions where cardiac conduction is, or could be, impaired.  Have underlying cardiac diseases such as congestive heart failure.  Are receiving other medications known to prolong prolong QT or potent CYP3A4 inhibitors.  Have severe hepatic impairment. If treatment is still required after a week, metoclopramide can be used for up to a week.

Supporting evidence review Your summary converted to a UKDILAS Summary (S00003) – to replace the Q&A on the website for now. What about linking the current Q&A to metoclopramide.

Entries on MidMed database: Summary: Domperidone and metoclopramide are considered to be compatible with breastfeeding as anti-emetics for short-term, low-dose use. Used mainly as galactogogues to increase milk production (off-label use) when they should only be used where there is objective evidence to support diagnosis and where non-drug methods have failed. Domperidone is considered to be the agent of choice for inadequate lactation because of its superior side effect profile, efficacy, and minimal passage into breast milk. Both should only be used of a maximum of one week (see individual entries)

Domperidone - Small amounts in breast milk. - Drug of choice for inadequate lactation. - Domperidone should not be used if the mother or infant has a cardiac disorder, liver impairment or are receiving treatment with drugs known to affect the QT interval e.g. ketoconazole or erythromycin, when metoclopramide preferred. - A maternal daily dose of 30mg domperidone for a maximum of one week should not be exceeded.

Metoclopramide - Small to moderate amounts in breast milk. - Evidence for effectiveness for inadequate lactation is limited. - Use only for a short period, in a dose not exceeding 30mg daily for a maximum of one week, and avoid in mother’s with a history of depression.