Motilium is a trade name for the drug Domperidone and is widely used to increase the milk supply, especially outside of the USA.
This is what Dr Thomas Hale writes about the drug in his book Medications and Mothers' Milk 2008.
DOMPERIDONE
Other Trades: Motilium, Motilidone
Uses: Gastrokinetic agent, galactagogue
AAP: Maternal Medication Usually Compatible with Breastfeeding
Domperidone (Motilium) is a peripheral dopamine antagonist (similar to Reglan) generally used for controlling nausea and vomiting, dyspepsia, and gastric reflux. It blocks peripheral dopamine receptors in the GI wall and in the CRTZ (nausea center) in the brain stem and is currently used in Canada as an antiemetic. Unlike metoclopramide (Reglan), it does not enter the brain compartment and it has few CNS effects such as depression.
It is also known to produce significant increases in prolactin levels and has proven useful as a galactagogue. Serum prolactin levels have been found to increase from 8.1 ng/lmL to 124.1 ng/mL in non-lactating women after one 20 mg dose. Concentrations of domperidone reported in milk vary according to dose. But following a dose of 10 mg three times daily, the average concentration in milk was only 2.6 ug/L.
In a study by da Silva, 16mothers with premature infants and low milk production (mean= 112.8 mL/d in domperidone group; 48.2 mL/d in placebo group) were randomly chosen to receive placebo (n=9) or domperidone (l0mg TID) (n = 7) for 7 days. Milk volume increased from 112.8 to 162.2mL/d in the domperidone group and 48.2 to 56.1 mL/d in the placebo group. Prolactin levels increased from 12.9 to 119.3 ug/L in the domperidone group and 15.6 to 18.1 ug/Lin the placebo group. On day 5, the mean domperidone concentration was 6.6 ng/mL in plasma and 1.2 ug/Lin breast milk of the treated group (n=6). No adverse effects were reported in infants or mothers.
The usual oral dose for controlling GI distress is 10-20mg three to four times daily although for nausea and vomiting the dose can be higher (up to 40 mg). The galactagogue dose is suggested to be 10-20 mg orally 3-4 times daily. The prior studies clearly suggest that doses of 10-20 mg three to four times daily elevate prolactin levels to levels more than adequate to produce milk. Doses higher than this should be avoided in breastfeeding mothers.
Recently the US FDA issued a warning on this product stating that it could induce arrhythmias in patients. These claims were derived from data many years old where domperidone was used intravenously as an antiemetic during cancer chemotherapy (20 mg stat followed by 10 mg/kg/24 h) Many of these patients were undergoing extensive chemotherapy and were extremely ill, and hypokalemic to begin with. Further, intravenous domperidone produces plasma levels many times higher than oral use. Thus far, we do not have any recently published data suggesting that domperidone used orally in breastfeeding mothers is arrhythmogenic.
Pregnancy Risk Category: C
Lactation Risk Category: Ll = SAFEST
Adult Concerns: Dry mouth, skin rash, itching, headache, thirst, abdominal cramps, diarrhea, drowsiness. Seizures have occurred rarely. Could induce arrhythmias in hypokalemic patients, or patients subject to arrhythmias.
Pediatric Concerns: None reported. Considered the ideal galactagogue.
Drug Interactions: Cimetidine, famotidine, nizatidine, ranitidine (H-2 blockers) reduce absorption of domperidone. Prior use of bicarbonate reduces absorption of domperidone.
Theoretic Infant Dose: 0.18 ug/kg/day
Relative Infant Dose: 0.04%
Adult Dose: 10-20 mg 3-4 times daily
Alternatives: Metoclopramide
(Bold is mine!)
Best wishes,
SARAH