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Papers about domperidone withdrawal syndrome

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ADMIN NOTE While domperidone is not used in psychiatric treatment, it is related to antipsychotic drugs, having the same adverse effects and withdrawal risk if taken daily for more than a month. We offer tapering information here because women taking domperidone to increase lactation can't find it anywhere else.

 

If you search for "domperidone" on this site, you will see case histories from others who have gotten withdrawal syndrome from domperidone or are tapering it.

 

Like psychiatric drugs, to avoid withdrawal symptoms, domperidone needs to be tapered. If you already have experienced withdrawal symptoms from domperidone, it's likely your nervous system is already sensitized to dosage decreases, and you are well advised to be very cautious in tapering off.

 

Why taper by 10% of my dosage?
 

Keep daily notes of drug schedule and symptoms to track patterns and progress

 

Tapering with a liquid is most convenient. You might be able to get domperidone liquid from a compounding pharmacy, but maybe not since technically, the drug is not approved for prescription in the US and many other countries. If so, you can make your own liquid:

Using an oral syringe and other tapering techniques
How to use oral syringes, gelatin capsules, powdered tablets, and do-it-yourself liquid solutions
 
How to make a liquid from tablets or capsules
General instructions on making a homemade liquid suspension

 

https://pubmed.ncbi.nlm.nih.gov/30000430/

 

Review

Domperidone

No authors listed
 
In: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006–.
 
2021 Aug 16.
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Excerpt

Domperidone is not approved for marketing in the United States by the U.S. Food and Drug Administration (FDA), but is available in other countries. Domperidone may also be available from some compounding pharmacies in the US. The quality of such products cannot be assured, and the FDA has warned against their use.[1]

 

Data available from 4 small studies on the excretion of domperidone into breastmilk are somewhat inconsistent, but infants would probably receive less than 0.1% of the maternal weight-adjusted dosage. No adverse effects have been found in a limited number of published cases of breastfed infants whose mothers were taking domperidone.

 

Domperidone is sometimes used as a galactogogue to increase milk supply.[2] Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[3,4] Most mothers who are provided instruction in good breastfeeding technique and breastfeed frequently are unlikely to obtain much additional benefit from domperidone. Several meta-analyses of domperidone use as a galactogogue in mothers of preterm infants concluded that domperidone can increase milk production acutely in the range of 90 to 94 mL daily.[5-7] Other reviewers concluded that improvement of breastfeeding practices seems more effective and safer than off-label use of domperidone.[8,9]

 

Domperidone has no officially established dosage for increasing milk supply. Most published studies have used domperidone in a dosage of 10 mg 3 times daily for 4 to 10 days. Two small studies found no statistically significant additional increase in milk output with a dosage of 20 mg 3 times daily compared to a dosage of 10 mg 3 times and that women who failed to respond to the low dosage did not respond to the higher dosage.[10,11] Dosages greater than 30 mg daily may increase the risk of arrhythmias and sudden cardiac death in patients receiving domperidone,[12] although some feel that the risk is less in nursing mothers because of their relatively younger age.[13] Large database retrospective cohort studies in Canada found an increase in the risk of cardiac arrhythmias and sudden cardiac death, but some confounders make the results subject to question.[14,15] In one case, domperidone use uncovered congenital long QT syndrome in a woman who developed loss of consciousness, behavioral arrest, and jerking while taking domperidone.[16] Mothers with a history of cardiac arrhythmias should not receive domperidone and all mothers should be advised to stop taking domperidone and seek immediate medical attention if they experience signs or symptoms of an abnormal heart rate or rhythm while taking domperidone, including dizziness, palpitations, syncope or seizures.[12]

 

Maternal side effects of domperidone reported in galactogogue studies and cases reported to the FDA include dry mouth, headache, dizziness, nausea, abdominal cramping, diarrhea, palpitations malaise, and shortness of breath. Some of these were more frequent with dosages greater than with 30 mg daily.[10,11,17-19] Surveys of women taking domperidone for lactation enhancement found gastrointestinal symptoms, breast engorgement, weight gain, headache, dizziness, irritability, dry mouth and fatigue were the most common side effects reported.[20,21] Drug withdrawal symptoms consisting of insomnia, anxiety, and tachycardia were reported in a woman taking 80 mg of domperidone daily for 8 months as a galactogogue who abruptly tapered the dose over 3 days.[22] Another mother took domperidone 10 mg three times daily for 10 months as a galactagogue and stopped abruptly. After discontinuation, she experienced severe insomnia, severe anxiety, severe cognitive problems and depression.[23] A third postpartum woman began domperidone 90 mg daily, increasing to 160 mg daily to increase her milk supply. Because her milk supply did not improve, she stopped nursing at 14 weeks and began to taper the domperidone dosage by 10 mg every 3 to 4 days. Seven days after discontinuing domperidone, she began experiencing insomnia, rigors, severe psychomotor agitation, and panic attacks. She restarted the drug at 90 mg daily and tapered the dose by 10 mg daily each week. At a dose of 20 mg daily, the same symptoms recurred. She required sertraline, clonazepam and reinstitution of domperidone at 40 mg daily, slowly tapering the dose over 8 weeks. Three months were required to fully resolve her symptoms.[24] In a fourth case, a mother took domperidone 20 mg four times daily for 9 months to stimulate breastmilk production. She stopped breastfeeding and domperidone at that time. Two weeks later, she presented with insomnia, anxiety, nausea, headaches and palpitations. The drug was restarted at a dosage of 20 mg three times daily and began to taper the daily dosage by 10 mg every week, but after one week she complained of insomnia. Tapering was reduced to 5 mg every week, but whenever she stopped the drug, symptoms returned. She was able to discontinue domperidone after tapering the daily dosage by 2.5 mg weekly over 10 months.[25]

Similar articles

References

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  • Altostrata changed the title to Drugs and Lactation Database, 2021 Domperidone Review
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J Hum Lact. 2021 Nov;37(4):748-760. doi: 10.1177/0890334420964070. Epub 2020 Oct 14.

Exploring the Prescribing Process of Domperidone for Low Milk Supply: A Qualitative Study Among Mothers, IBCLCs, and Family Doctors

Lara A Tauritz Bakker 1, Liset van Dijk 2 3, Patricia M L A van den Bemt 4

Affiliations expand

PMID: 33180685

PMCID: PMC8641033

DOI: 10.1177/0890334420964070

 

Abstract at https://pubmed.ncbi.nlm.nih.gov/33180685/

Background: When mothers are confronted with milk supply problems, taking domperidone is regularly suggested. However, domperidone has been associated with sudden cardiac death and caution in prescribing is advised. In 2016, a multidisciplinary group of authors from a tertiary academic hospital (Erasmus MC) published a clinical protocol in a leading Dutch physicians' journal to support Dutch family physicians in prescribing domperidone to stimulate lactation.

Research aim: To explore consumer and health care provider perspectives and experiences regarding the prescribing of domperidone for lactation insufficiency following publication of a national clinical protocol.

Methods: A cross-sectional qualitative study was performed using semi-structured interviews (N = 40) based on a topic list covering the prescribing process. Participants were mothers (n = 18) who had been advised to try domperidone to boost their milk supply between November 2016 and May 2018, their International Board Certified Lactation Consultants (n = 9), and their family physicians (n = 15). Another group of participants (mothers; n = 6) answered short questionnaires. All interviews were recorded, transcribed and analyzed using ATLAS.ti software. The resulting list of codes was organized according to the topics.

Results: In the process leading to domperidone use to stimulate lactation, participant family physicians relied on the IBCLC, pharmacist, or mother to guide the prescription of domperidone, often citing the published national clinical protocol as back up. The medical safeguards incorporated in the protocol (e.g., taking medical history, physical exam, performing electrocardiograms, limiting dosage) were usually not implemented.

Conclusions: Though the availability of a national clinical protocol in which the prescribing of domperidone for lactation is supported appeared to increase the willingness of participant family physicians to prescribe, gaps were identified between clinical practice and this clinical protocol for prescribing domperidone.

Keywords: breastfeeding; galactogogues; induced lactation; insufficient milk; lactation difficulties; lactogenesis.

 

Free full text on PubMed Free full text on Journal of Human Lactation

 

Quote

Researchers of four case studies have reported withdrawal symptoms after extended use for lactation, including insomnia, anxiety, and tachycardia (90–160 mg daily for 14 weeks, 80 mg daily for 8 months, 80 mg daily for 9 months, 30 mg daily for 10 months). These cases required very slow tapering to resolve symptoms (Doyle & Grossman, 2018; Manzouri & Mink, 2017; Papastergiou et al., 2013; Seeman, 2015).

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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British Journal of General Practice, January 2014

Yes, breast is best, but taper domperidone when stopping

  • Philip Seeman, Professor, Departments of Pharmacology and Psychiatry
15 January 2014 
 

As wisely outlined by Rosie Sayers,(1) breastfeeding is best for the child and the mother. The recommendation by WHO to breastfeed in the first six months means that the off-label use of domperidone (to increase breast milk flow) by mothers will increase. La Leche League endorses this. In Australia, 5% of new mothers use domperidone. It is important, therefore, for family physicians to be aware of the domperidone withdrawal syndrome, and to advise that the withdrawal of domperidone be gradually tapered.

 

The failure to taper domperidone when stopping breastfeeding can sometimes be disastrous. In one example, a 41-year-old woman (patient wishes to remain anonymous, but has given information and consent for publication) delivered a baby by caesarian section at University College London Hospital, in February 2012. Six weeks after delivery her physician prescribed domperidone (10 mg TID) to increase her breast milk. Ten months later, in January 2013, she abruptly stopped domperidone and breastfeeding in order to conceive another child. 

She immediately developed severe insomnia for 3 to 4 days at a time. She developed akathisia, severe anxiety, and difficulty swallowing. She was very depressed and felt she was 'putrefying inside', developing a delusion she had lost her internal organs. She suffered severe cognition and memory problems; she wandered for two hours in a supermarket unable to shop. Previously active as a lawyer with no earlier psychiatric history, she now lost all motivation and stopped taking care of herself. She planned suicide. On March 22, 2013, she was prescribed olanzapine 'for the psychosis', but only took an occasional dose. She was separately assessed by nine consultant psychiatrists, but no clear diagnosis was established. Ten months after stopping domperidone she was still having withdrawal side effects. 

 

While domperidone readily blocks dopamine D2 receptors in the gastrointestinal system, it has been reported to be unable to permeate the blood-brain barrier.(2) However, there are reports of domperidone eliciting adverse motor side-effects,(3) indicating it can enter the brain. Domperidone is a potent antagonist of dopamine D2 receptors with an affinity for the D2 receptor twice that of haloperidol.(4) Therefore, if it enters the brain, the effects of long-term domperidone are expected to be similar to those of long-term haloperidol, including an increase in dopamine D2 or D2High receptors, associated with behavioural dopamine supersensitivity.(4) 

 

The time course, the psychotic symptoms, and the basic pharmacology all indicate that the patient developed 'dopamine supersensitivity psychosis'(5) after stopping the long-term use of the domperidone antipsychotic.

Psychosis, insomnia, intense anxiety, and tachycardia caused by the sudden withdrawal of domperidone are not unusual.(6) Breastfeeding websites reveal disturbing stories of women who became extremely anxious, depressed, and psychotic upon sudden withdrawal of domperidone.

 

In this patient, the withdrawal reaction lasted ten months.

 

References
1. Sayers R. Breast is best: just maybe in private? Brit J Gen Pract 64(618) DOI: 10.3399/bjgp14X676573.
2. Laduron PM, Leysen JE. Domperidone, a specific in vitro dopamine antagonist, devoid of in vivo central dopaminergic activity. Biochem Pharmacol 1979; 28: 2161-2165.
3. Barone JA. Domperidone: a peripherally acting dopamine-2-receptor antagonist. Ann Pharmacother 1999; 33: 429-440.
4. Seeman P. All roads to schizophrenia lead to dopamine supersensitivity and elevated dopamine D2High receptors. CNS Neurosci Therap 2011; 17: 118- 132. 
5. Chouinard G, Chouinard VA. Atypical antipsychotics: CATIE study, drug-induced movement disorder and resulting iatrogenic psychiatric-like symptoms, supersensitivity rebound psychosis and withdrawal discontinuation syndromes. Psychother Psychosom 2008; 77: 69-77.
6. Papastergiou J, Abdallah M, Tran A, Folkins C. Domperidone withdrawal in a breastfeeding woman. Can Pharm J (Ott) 2013; 146: 210-212.

Conflict of Interest:

None declared

Competing Interests: None declared.
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This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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