The following is a guest post from the doctor who wrote A cardiologist’s experience with a “baby friendly” hospital warning women about the off label use of domperidone (a drug typically used to suppress nausea) to improve milk supply in breastfeeding mothers. This message could save your life:
Domperidone is a non-FDA approved drug which is often touted to breastfeeding mothers as a remedy for low supply. It’s available over the counter in many European countries, and can easily be obtained from internet pharmacies.
As a cardiologist, I’m very concerned about this drug, and the European Drug safety agency agrees. Here’s why:
1. Domperidone prolongs the QT interval. This means that it alters the speed and duration of certain electrical currents in cardiac muscle cells, making them very susceptible to a dangerous arrhythmia called torsades de pointes. If this occurs, the heart stops beating and the patient will die unless she is shocked with a defibrillator within seconds. Survivors often suffer from HIE.
2. QT prolonging drugs are silent killers. The first symptom that anything is amiss is that the patient literally drops dead from a malignant arrhythmia. The only (imperfect) way to screen for it would be to do serial ECG’s before and after starting the drug in a hospital environment with full resuscitation equipment nearby. Obviously this is not going to happen with an off-label drug bought off the internet.
3. When a woman is taking this drug on her own initiative from an internet pharmacy, she probably won’t mention it to her doctor. If she is prescribed another drug with QT prolonging effects on top of the domperidone, eg a quinolone antibiotic for postpartum UTI, or antidepressant for PPD, she is at an extremely high risk for arrhythmias. The list of QT prolonging meds is very long and keeps growing, so ideally a doctor should consult it for every new prescription to a patient taking domperidone.
4. Advising a woman to risk her life with this dangerous drug only to be able to breastfeed, is so fundamentally unethical it makes my blood boil. The only excuse these lactation consultants and midwives have is that they don’t have the knowledge to understand what they are doing. Someone who hasn’t been to medical school really has no business playing with this stuff.
5. If the risk to the mother isn’t enough, there’s a risk to the baby too. Domperidone is transferred in breastmilk (LC’s often deny this!) and infants are exquisitely sensitive to its effect. How many ‘SIDS’ cases out there are in fact sudden cardiac deaths from arrythmias caused by maternal domperidone use?
6. Breastfeeding support organisations bear a shattering responsibility here. Where is the big lettered warning on the La Leche League website? Where is their official position statement forbidding their leaders to endorse this drug? They have blood on their hands.
My bottom line is: it isn’t worth it. If you need domperidone to keep your supply, throw it out and start supplementing. You risk death or permanent disability, not only for yourself but for your baby too. I know firsthand how heartwrenching it is to want to breastfeed your baby, and not be able to. The feelings of guilt, fear and inadequacy combined with postpartum emotional vulnerability are completely overwhelming. It’s enough to make the most levelheaded woman look into these harebrained methods. Please don’t make yourself a victim.
Editor’s note: The recommendation to use domperidone off label to increase breastmilk supply shines a light on the essential hypocrisy of the natural childbirth and homebirth movements. The same people who are shocked about the off label use of Cytotec, and imply that off label means illegal, seem to have no problem with the off label use of domperidone. What’s the difference? Modern obstetrics is “bad” and the off label use Cytotec “proves it.” But breastfeeding is “good” so anything, even the off label use of a drug that might kill the mother, must be “good.”