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 ( NNU s). 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%) NNU s. All 16 (100%) NNU s 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 NNU s 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.