Efficacy and safety of domperidone and metoclopramide on human milk production in postpartum mothers: a bayesian network meta-analysis of randomized controlled trials

BACKGROUND: Breastfeeding is the most advantageous nutrition for infants because of its many health benefits. However, lactation insufficiency is a prevalent issue among women, particularly those who give birth prematurely. Galactagogues, such as domperidone and metoclopramide, have been reported and may be beneficial for lactation insufficiency. However, the optimal pharmacological galactagogue remains unclear. METHODS: The PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library databases were searched from their inception to April 23, 2023. The primary aim of this research was to assess the efficacy and safety of domperidone and metoclopramide using Bayesian network meta-analysis. The efficacy outcome was the increased breast milk volume (in mL/day). The safety outcome was the frequency of maternal drug-related adverse events during the study period. RESULTS: Seventeen randomized controlled trials were included in the final analyses. Preterm mothers who took domperidone had a greater increase in breast milk volume than those who took metoclopramide or placebo (domperidone vs. metoclopramide: MD = 82.84, 95% CI: 37.04-118.95; domperidone vs. placebo: MD = 88.30, 95% CI: 59.48-118.62). However, in the term mothers, domperidone did not show the above benefit compared with metoclopramide or placebo (domperidone vs. metoclopramide: MD = 93.67, 95% CI: -186.11-375.59; domperidone vs. placebo: MD = 126.25, 95% CI: -49.91-304.55). Both in preterm and term mothers, metoclopramide was no better than the placebo. There was no difference in the frequency of maternal drug-related adverse outcomes among domperidone, metoclopramide, and placebo. CONCLUSION: Domperidone increased the daily breast milk volume in mothers of preterm infants, without serious adverse events. However, this conclusion is limited due to the small sample sizes in the studies analyzed.