Domperidone –

withdrawal
symptoms
Agusnawati
 TABLE OF CONTENTS
Domperidone Discussion
The mechanisms and use 01 03 The disscussion on the
doses case report

Case report conclusion

Some case report with 02 04 The clinical implication
withdrawal symptoms of
domperidone
 01
Domperidone
The Mechanisms and use doses
 domperidone
• High-affinity antagonist of dopamine-2 (D2) receptors
• Dopaminergic blockade → stimulates the release of stored prolactin in
the anterior pituitary.
• In the brain, dopamine antagonism produces an antipsychotic effect →
central nervous system effects are rarely → minimal transfer across the
blood-brain barrier, mainly in the upper gastrointestinal system.
• The dopaminergic and serotonergic (5-HT) systems → interconnected in
the modulation of cognition, emotion, and behavior of the central
nervous system.
 domperidone
• For gastric indications → the maximum recommended dose is 30–
40 mg/day for limited durations
• For galactagogue doses → vary widely and range as high as 180 mg/day
• No research → doses >60 mg/day produce higher prolactin levels or milk
production
• 30 mg/day was blocked between 9% and 57% of the central D2 receptor,
• 160 mg/day, the blockade can be up to 89%
• from 2 days to 3 to 4 weeks postpartum studies, 7 and 28 days.
• Maximum effect → reached by 7–14 day
• Side Effects → : Dry mouth, headache (resolved with decreased dosage),
and abdominal cramps
• Tapering of dose is usually recommended
 02
Case reports
Some case report with withdrawal symptoms
of domperidone

Papastergiou, et Al (2013)
• The first incident of psychiatric
symptoms
• Tachycardia, and insomnia →
abrupt withdrawal from 80 mg/day.
Conventional antidepressants →
ineffective.
• Reinstating the 80 mg/day dose
with a 10 mg/week taper →
effective in resolving
symptomology.
Case Reports
Seeman (2014)
• 30 mg/day for 8 months.
• After abrupt discontinuation, →
insomnia, severe anxiety,
akathisia, dysphagia, and
cognition and memory issues
resulting in suicidal ideation for at
least 10 months.
MARManzouri & Mink (2017)
• 80 mg/day for <9 months abruptly
discontinued the dose,
• resulting in insomnia, anxiety,
nausea, headache, and
palpitations 2 weeks after the last
dose.
• After resuming 60 mg/day to
mitigate withdrawal symptoms
• The final taper required a dose
reduction of 2.5 mg every 2
weeks.
 Case Reports

Doyle & grossman (2018) Currie (2021)

• 160 mg/day.
• Thesis study interviewed 18
mothers regarding their off-label
• After 14 weeks of treatment, she tapered
use of domperidone in Canada.
by 10 mg every 3 to 4 days until reaching
a dose of 20 mg/day when she stopped
• Two of the 18, unprompted,
reported “devastating” psychiatric
the drug entirely.
symptoms, including anxiety,
• A week later→ insomnia, rigors,
dysphoria, and akathisia, within
psychomotor agitation, and panic
days of stopping or reducing
attacks.
domperidone.
• She resumed a dose of 90 mg/day with a
10 mg/week dose reduction, but
symptoms reemerged when she reached
20 mg/day.
• The final phase of dosage tapering took
3 months to complete without recurring
withdrawal symptoms.
 Case Reports
Sharma et al (2022)
• Patient with a preexisting psychiatric history,
• The mother experienced a reemergence of
obsessive-compulsive disorder and major
depressive disorder 1 week following the abrupt
discontinuation of 120 mg/day of domperidone
after 6 months of use.
• Other symptoms included insomnia, anxiety,
irritability, poor concentration, loss of libido, and
lack of energy; she denied thoughts of suicide.
• The reintroduction of domperidone at
120 mg/day with a 10 mg/week taper (without the
support of other psychotropics) ultimately
succeeded in remission of her symptoms
• she sought psychiatric support halfway into the
taper.
Bon &ASMA (2022)
• Case of adoptive mother with infanticide to her second
adoptive baby
• After 3 months on 3x20mg/day of domperidone
• She lost her first adoptive baby 8 months earlier → to
depression
• Sudden onset of intrusive thoughts of harming her
second child, which was described as “thought to kill
and slaughter” with flashes of violent images.
• Her working diagnosis was domperidone-induced
obsessional thoughts with adjustment disorder.
• Duloxetine, a selective serotonin and norepinephrine
reuptake inhibitor (SNRI) 30 mg once daily was
prescribed and gradually optimized to 60 mg once daily
over 2 months.
• Concurrently, she received supportive therapy and grief
counseling sessions.
• The intrusive infanticide thought improved after 2
months of treatment followed by significant
improvement of the depressive symptoms.
• Remission was achieved after 10 months of treatment.
• Continue the duloxetine at 30 mg once daily until further
review.
 Elleana
Majdinasab
et al
(2022)
 03
Discussion
The discussion on the case report
 Discussion
•

•
 treatment
•

•
 04
conclusion
The clinical Implication
• Therefore, lactating patients with psychiatric symptoms
should be explicitly asked about domperidone use as a part of
their medical history.
• Mothers who wish to induce lactation using pharmacological
galactagogue should undergo thorough physical and mental
health assessments in addition to breastfeeding consultation.
• Cautious prescription of galactagogue should be practiced for
mothers who have had a history of depressive or psychiatric
symptoms as they were potentially at a greater risk to
develop neuropsychiatric complications.

Clinical implication
 References
• The Academy of Breastfeeding Medicine. ABM Clinical
Protocol #9: Use of Galactagogues in Initiating or
Augmenting Maternal Milk Production, Second Revision
2018. Breastfeeding Medicine Volume 13, Number 5, 2018
DOI: 10.1089/bfm.2018.29092.wjb
• Shen Quan, et al. Efficacy and Safety of Domperidone and
Metoclopramide in Breastfeeding: A Systematic Review and
Meta-Analysis. Breastfeeding Medicine Volume 16, Number
7, 2021. DOI: 10.1089/bfm.2020.0360
• Bon Rosnadia Suain, Mahmud Asma Assa’edah.
Domperidone Use as a Galactagogue and Infanticide
Ideation: A Case Report. Breastfeeding Medicine. Volume
17, Number 8, 2022. DOI: 10.1089/bfm.2022.0016
• Majdinasab Elleana, et al. Psychiatric Manifestations of
Withdrawal Following Domperidone Used as a
Galactagogue. Breastfeeding Medicine. Volume 17, Number
12, 2022. DOI: 10.1089/bfm.2022.0190
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