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Pharmacological management of low milk supply with domperidone: separating fact from fiction

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To the Editor: After publication of our peer-reviewed perspective article on the safe and effective use of domperidone in the management of low milk supply,1 we are disappointed to have been informed that the Australian medicines handbook (AMH) has removed lactation stimulation as a recognised off-label indication for domperidone (as well as metoclopramide). It appears that this change could be a kneejerk response to recent regulatory warnings, despite these being highlighted as not being of relevance to most breastfeeding women.1,2 These changes carry with them the significant potential to create confusion among prescribers and the public.

We would like to re-emphasise the points we have made previously that further restrictions regarding the use and availability of domperidone do not appear to be warranted; they risk subjecting women to additional emotional trauma and are not in the interests of the immediate and long-term health of breastfeeding women and their babies.1,2 There is absolutely no evidence that domperidone places breastfeeding mothers at increased risk of severe cardiac events, whereas, in contrast, there is evidence of the significant benefits to be gained from the use of…