In Canada, the College of Physicians and Surgeons of Ontario warn about domperidone, originally for stomach problems but used off-label to increase breastmilk production.

In October of 2019, Joanna McCabe, a nurse, saw a lactation specialist, Dr Newman, with concerns about her breastmilk production and was prescribed 90mg/day, with another doctor increasing it to 120mg/day. When she stopped the drug, she developed anxiety, suicidal ideation, and was afraid she might harm her children, telling her husband not to leave her alone with them.

She saw a psychiatrist who prescribed antidepressants and benzodiazepines, to which she now believes she’s dependent. An investigation by the Order of Physicians found that she was prescribed four times the maximum dose (30 mg) even for on-label use– without informing her of risks and need to taper. The investigation also found that she had been producing enough breastmilk in the first place.

In the US, domperidone is not FDA approved for any use, they issued warnings, in 2004 and 2012, about serious cardiac events, including sudden death, and neuropsychiatric adverse events in women who used it to increase breastmilk supply. In December 2022, CBC published an article questioning why the drug was still in use in Canada, considering it being banned in the US and in 2023, Health Canada study noted the risks associated with suddenly stopping the drug.

Sources:

Carman, Tara. 22 April 2024. “Allaitement : un médicament controversé pour la lactation.” (Breastfeeding: a controversial drug for lactation.) Radio Canada.

Gomez, Chelsea and Tara Carman. 5 Dec 2022. “Banned in the U.S., not approved for breastfeeding — why are so many moms taking this drug?” CBC.

Information about Domperidone. FDA.