Using domperidone to increase breast milk supply: a clinical practice survey of Australian neonatal units

Background: Domperidone may be used off-label to increase breastmilk supply. In the absence of manufacturer dosage recommendations, there is a need to compare the clinical practice guidelines used in Australian hospitals. Aim: To compare existing clinical practice guidelines regarding the use of domperidone for increasing maternal breastmilk supply within Australian neonatal units (NNUs). Methods: An electronic survey was distributed from April to July 2015 to relevant staff at each Level III NNU across Australia. Results: Responses were received from 16 of 22 (73%) NNUs. All 16 (100%) NNUs considered domperidone their first line pharmacological agent of choice in the management of low milk supply, with 12 (75%) having a clinical guideline. Of the NNUs with a guideline, 11 (92%) recommended a standard maintenance dose of 10 mg three times daily (TDS). Duration of treatment was specified in 10 (83%) guidelines. Seven of 10 (70%) recommend a minimum duration of at least 2 weeks treatment before evaluating a response. Three of 11 (27%) guidelines that recommended 10 mg TDS permitted an increase to 20 mg TDS depending on response. Ten of 12 (83%) guidelines were modified in the previous 2–3 years, with eight revising their maximum dose to 30 mg/day, one limiting treatment duration to 7 days, and one removing the authority of NNU doctors to prescribe domperidone. Conclusion: While all Australian neonatal units consider domperidone first-line for pharmacological management of low milk supply, variability across clinical guidelines may suggest a lack of reliable evidence or awareness of evidence on which to base practice.Christine E. Gilmartin, Lisa H. Amir, Marene Ter, Luke E. Grzeskowia