Concerns have been raised by The College of Physicians and Surgeons of Ontario regarding the prescribing practices of a Toronto-based doctor specializing in breastfeeding, Dr. Jack Newman. In a recent case, a woman was prescribed domperidone, a medication approved in Canada for digestive issues but frequently used off-label to boost lactation, despite controversy surrounding its effectiveness and potential risks.
Domperidone is often recommended to women experiencing difficulties with breastfeeding to enhance milk production, sometimes at dosages exceeding Health Canada’s recommended limits. However, its off-label usage has stirred debate due to the severe withdrawal effects experienced by some individuals, including psychological symptoms, upon abrupt cessation. This was the unfortunate experience of complainant Joanna McCabe.
An independent assessment, commissioned by the College, concluded that Joanna had an adequate milk supply and did not require the medication. The assessor highlighted deficiencies in Dr. Newman’s approach to care, citing a failure to meet the standard expected of a breastfeeding specialist in Ontario.
Recommendations from the College emphasized the need for Dr. Newman to undergo further education on the prescription and management of domperidone, particularly concerning adverse events and patient education. Despite being approved as a digestive aid, domperidone’s impact on lactation and its potential psychiatric effects underscore the importance of informed decision-making in its prescription.
Joanna’s ordeal sheds light on the complexities surrounding domperidone usage. Despite her medical background as a registered nurse, she was directed to take the medication by Dr. Newman to address breastfeeding concerns with her infant daughter. However, Joanna contends that she was not properly informed about the risks and proper weaning procedures.
The College’s inquiry highlighted gaps in patient education and risk assessment surrounding domperidone. While Health Canada had issued warnings about its cardiac side effects, psychological withdrawal effects were not widely recognized until later. Dr. Newman, in response to Joanna’s complaint, insisted that he had always advocated for gradual discontinuation of the medication but acknowledged the need for heightened awareness regarding its potential psychiatric effects.
Joanna’s experience, characterized by intrusive thoughts and severe anxiety upon quitting of the medication, highlights the need for improved patient communication and care protocols. Despite seeking psychiatric treatment for her symptoms, Joanna struggled with dependency on additional medications, adding her ordeal.
A retrospective review by Health Canada in 2023 confirmed the risk of psychiatric withdrawal effects associated with domperidone discontinuation. Joanna, reflecting on her journey, expressed regret at not being informed of the medication’s antipsychotic properties, asserting that she would have made a different choice had she been aware.
The independent assessor’s evaluation questioned the necessity of domperidone in Joanna’s case and raised concerns about the clinic’s management of her care. Dr. Newman has committed to self-study to address the College’s concerns, aiming to improve patient outcomes and mitigate potential harm.
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