Domperidone/Motilium: A Commentary

How Domperidone Works:
Domperidone induces lactation by artificially regulating Prolactin secretion by the Pituitary gland. How it regulates Prolactin secretion is important.

Prolactin secretion by the Pituitary gland is normally regulated by the chemical neurotransmitter Dopamine. When normal levels of Dopamine come in direct contact with receptors at the Pituitary gland, Prolactin secretion is regulated at about 9 nanograms of Prolactin per Milliliter of blood for women. (about 5 nanograms of Prolactin per Milliliter of blood for men)

Domperidone chemically blocks the Dopamine receptors at the Pituitary gland: inhibiting the normal regulating function of Dopamine. Inhibiting the normal regulating function of Dopamine at the Pituitary gland, has the effect of increasing secretion of Prolactin. Dramatically elevated levels of Prolactin in the female bloodstream, (caused by the effects of Domperidone), stimulate female Mammary glands into milk production.

Unlike Reglan/Metoclopramide, Domperidone does not readily cross the blood/brain barrier, and does not normally cause depression.

It is important to remember: as long as Domperidone levels remain high in the female bloodstream, Prolactin levels remain high in the bloodstream.

The Unseen Danger:
To understand how Domperidone may present an unseen health risk, it is necessary to understand how natural lactation occurs as opposed to chemically induced lactation.

Whether natural or chemically induced, lactation requires elevated levels of Prolactin in the bloodstream. However, when lactation occurs naturally, Prolactin secretion is increased only for a few seconds during each Letdown Reflex.

During this brief period of increased Prolactin secretion, the Pituitary gland releases only enough Prolactin to last from 9 to 20 minutes. Should it be necessary to breast feed beyond 20 minutes, a second and third Letdown Reflex will occur; there by allowing lactation to continue as needed.

When lactation is induced naturally, excess Prolactin is normally purged from the blood within 20 minutes. However, when lactation is chemically induced, Prolactin levels remain high as long as Domperidone is present in the bloodstream. Chronic high levels of Prolactin in the bloodstream can create a health risk for some people.

Normally, elevated levels of Prolactin in the bloodstream present little or no threat to a woman's health; however, some breast cancers are Prolactin dependent. (In other words, some breast cancers need Prolactin to spread) In rare cases, chronically high levels of Prolactin in the bloodstream, (caused by the effects of Domperidone), may actually stimulate new growth in normally dormant cancer cells.

Also, Prolactin is not the only hormone produced by the Pituitary gland. The purpose of the Pituitary gland is to produce multiple hormones, which in turn, regulate multiple body functions. And because Domperidone is a Dopamine inhibitor: production of any hormone regulated by Dopamine, (whether directly or indirectly), will be affected. And a chronic imbalance in hormone levels can create health risks for some people.

Example: By over stimulating production of Thyroid Stimulating Hormones, (TSH), Domperidone may increase health risks from a potentially hyperactive Thyroid gland. In cases where a Thyroid gland is already at risk because of preexisting hormonal imbalances, the effects of Domperidone on hormone production may be enough to tip the scales.

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