Ontario doctor's college cautions Toronto pediatrician over breastfeeding drug

The College of Physicians and Surgeons of Ontario has expressed concern about the prescribing and oversight practices of a Toronto breastfeeding doctor in a case where a woman was prescribed domperidone, whose off-label use to induce lactation is controversial. 

Domperidone is approved in Canada as a digestive aid, but commonly prescribed off-label to women struggling to breastfeed as a way to increase milk supply, sometimes at doses several times higher than Health Canada's recommended maximum of 30 mg/day. 

Some women who take it suffer severe psychological withdrawal effects when they stop it abruptly, which is what happened to complainant Joanna McCabe.

McCabe was producing enough breast milk and did not need the medication, according to an independent assessor who reviewed the complaint against Dr. Jack Newman. 

"The Respondent did not meet the standard of care of a breastfeeding medicine physician practicing in the Province of Ontario," the assessor wrote in a complaint decision issued by the College Feb. 28, 2024 and obtained by CBC News.

Newman would benefit from further education on "prescription of domperidone for lactation; management of adverse events related to domperidone; management of patients being tapered on domperidone; patient education regarding domperidone for lactation," the College's Inquiries, Complaints and Reports Committee wrote in the decision.  

There were approximately 1.7 million prescriptions for domperidone filled in 2021, according to Health Canada. It's not known how many were for lactation. A CBC analysis of partial data from B.C., Saskatchewan, Manitoba and publicly-insured residents of Quebec found that out of nearly two million people prescribed domperidone between 2000 and 2021, more than three-quarters were women in their childbearing years.

It can also act as an antipsychotic, because it blocks dopamine receptors in the brain. 

In December 2022 CBC News published the accounts of two women who suffered severe psychological withdrawal effects when they stopped taking the drug abruptly, symptoms they say they were not warned about. One of those women – a resident of the U.S., where domperidone is not authorized for any purpose – was prescribed by Newman. 

McCabe says listening to the CBC's coverage made her wonder if this is what had happened to her.

McCabe was referred to Newman in October 2019 for breastfeeding concerns with her infant daughter, including breast infection and pain, according to the complaint.

McCabe, a registered nurse, told CBC in an interview she knew her daughter had a tongue and lip tie which were causing difficulties breastfeeding and went to Newman's Toronto clinic, the International Breastfeeding Centre, seeking a corrective procedure to fix them. She said she was told by Newman at the time that she needed to take domperidone to increase her milk supply. 

Newman prescribed McCabe 90 mg per day of domperidone, according to the complaint.