Stopping high doses of domperidone, drug used for breastfeeding, can cause withdrawal, Health Canada warns

A Health Canada review has found there is a risk of psychiatric withdrawal effects when women using the drug domperidone to stimulate breast milk production suddenly stop taking it.

Health Canada will update the product monograph, or scientific description of a drug's properties "to note that cases of psychiatric withdrawal events have been reported," the regulator said in a statement posted on its Drug and Health Product Portal. It has also issued updated guidance to doctors and other health care providers informing them of the risk.

Domperidone is a gastrointestinal medication approved in Canada to speed up digestion at a recommended maximum dose of 30 mg per day. A CBC investigation in December 2022 found it is regularly prescribed at doses several times higher than that to help women produce breast milk, a purpose for which it has never been authorized in Canada.

Domperidone is also prescribed off-label for other reasons, including to stimulate lactation using doses typically three- to five-times higher than the approved gastrointestinal use. Of the nine cases reviewed by Health Canada, eight involved doses higher than 30 mg/day to stimulate lactation.

Women told CBC that when they stopped taking the drug, they experienced extreme anxiety, panic attacks, insomnia and intrusive thoughts so severe they were left unable to function or care for their children, often for months.

Some women were forced to stop working or move in with their parents. At least one attempted to take her own life.

Montreal resident Jamie Robinson experienced debilitating panic attacks and extreme anxiety when she stopped taking domperidone, eight months after the birth of her daughter. She recalls struggling to explain it to doctors, some of whom told her she had postpartum depression.

"I felt like there was so much difficulty in conveying the level of crisis that domperidone brought into my life that words like anxiety or depression … can't even begin to broach the intensity of the experience," she said.

Robinson's psychologist, Karen White, connected her sudden and severe reactions to stopping domperidone, which blocks dopamine in the brain and can act as an antipsychotic. 

At home and mentally unable to work or care for her child, Robinson went looking for reports of similar reactions and found little in the way of medical guidance. But on social media, she found dozens of other mothers who had experienced similar symptoms when they stopped taking domperidone.

She compiled their experiences into a blog in the hope, she said, that other women would have the information about stopping the medication that she didn't. 

Robinson also encouraged the women to report their symptoms to Health Canada's Adverse Reaction Online Database.

Two years later, a Health Canada review of the reports in that database and published case studies in other countries confirmed the link.

"Health Canada's review of available information found an association between abruptly discontinuing or tapering domperidone, used off-label for lactation stimulation, and psychiatric withdrawal events including, but not limited to, depression, anxiety and insomnia," the agency said in a statement to CBC. The review started in December 2022.