I got a private post asking me if my post about domperidone was suggesting I
think it's a better galactagogue than metaclopramide.  Here is a
clarification of my remarks:

After 21 yrs in the field I've had many experiences both positive and
negative with metaclopramide (Reglan).  The side-effects (mostly depression,
jitteriness, sleeplessness, or conversely, sleepiness) are a huge problem to
the moms they affect.  Luckily the side-effects stop when the drug is
discontinued.  I've also had many moms do fine on a short, ten-day course of
Reglan, which has produced no ill effects and bumped their temporarily
depressed milk supply back to where it should be.  However, that said, I too
prefer domperidone due to it's reduced risk of side effects. No drug is
without side effects and just this month I saw a mom break out in a very
itchy rash when she began using domperidone.   This is a side-effect that is
listed in the literature in regards to this drug.  A minor (and rare but
still possible risk) of domperidone is seizure.  Additionally, while
domperidone is now legally available through US compounding pharmacies, no
insurance plans cover it.  Consequently, many women are unable to afford it,
while their insurance co. will pick up the cost of a course of Reglan.  So
sometimes that's a management consideration.  All this aside, the main point
of my post to Lactnet was not the touting of metaclopramide as the better
galactagogue.  I agree with you that in my experience  and in my reviews of
the lit. domperidone is better and safer and certainly the mom who needs it
long term will have a much better time on this drug.  My point was that
IBCLCs (unless they are also MDs or PNPs with prescriptive privileges) are
not ethically supposed to be arranging drug buys.  They can provide
information about medications to mothers and other HCPs.  Ideally this info
comes from the literature and winds up being legally prescribed.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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