Dear Lactnet,
On the heels of Lyla W's inquiry about Reglan and letdown, I have some
questions about Reglan and long-term use.
The mom I am working with started it one week ago and noticed a
significant increase in supply. In fact, she went from producing colostrum
to mature milk. She never experienced any fullness, but noticed tingling and
milk dripping within 24 hours of taking it..............Day 8. I thought it
could be coincidental with her "milk coming in" anyway but now we will never
know.
This is her 5th boy. The brothers are 9 years down to 19 months. Mom is
former nurse/dad is surgeon. Periareolar incisions for implants in 1987 but
has breastfed other 4 boys.
I have seen her with last 2 babies d/t SWG and classic nipple soreness.
Each time she resolved the problems with positioning, extra pumping and
supplementation.
With this baby I came in on the case at 72 hours. Down a full pound.
Great latch, limited colostrum. Began SNS and waited for milk volume to
increase.
There are no red flags in her history to explain the delayed onset of
milk. No tyhroid, that we are aware of, easy vaginal birth, no anemia, no
meds, great latch, breast changes in pregnancy etc.
I obviously thought retained placenta, but mom called OB to inquire about
U/S and they said no symptoms and she did respond to Reglan. Flow is tapering.
She is on a dosage of 10 mg TID. No overt side effects. Also, taking
Fenugreek capsules. Baby has gained 24 oz in 10 days (he was down a pound,
remember) and he is now averaging 1-2 oz a day. His birthweight was 9 lb 2
oz, now at 2 weeks up to 9 lb 10 oz. She pumps with an 015 classic after
several feeds and gets 10-15 ccs a side. After using the SNS at every feeding
for a week, she is using the SNS with 60 cc up to 4 times a day and he
leaves some behind usually. She has rented scales and the most he has
transferred without the SNS is 75 cc in the morning. He averages 48-65 cc at
breast.
My questions are as follows:
* She wants to know why she can't just stay on Reglan? My "Clinical Therapy
in BFing Patients" by Dr. Hale suggests "long term use of this medication (>4
wks) is generally not recommended as the incidence of depression increases."
* Is the depression because of dopamine effects or what? Any stats on the
rate of incidence after one month??
* If she switched to Domperidone (I initially suggested this/ gave her Dr.
Newman's handouts) can she stay on it long-term? How long? How much is it US
dollars?
* If she had retained placenta would the Reglan have overridden her system
to produce mature milk?
* If she were to taper off the Reglan and supply dropped dramatically, could
she reinstitute its use and expect the supply to rise again?
If you have had experience with these issues please let me know. The moms at
my hospital mainly have taken it for 10 days and thus I have not had anyone I
have worked worked with who has had these questions.
This mom is dedicated and had really gone the extra mile. I hope she can
continue as she has, even though she may still use the SNS a few times a day.
I have talked with several LC's locally and none of us can come up with
etiology as to the "milk not coming in". The previous breast surgery clouds
the issue, but she did feed the other 4 babies without this type of problem.
At night she sleeps with him and nurses throughout the night. I have
suggested she try 48 hours of no SNS and see what happens, esp. since there
is always residual milk when she pumps. She is back to carpool, soccer
practice, groceries etc after a 2 week focus on getting started. I hope to
have some answers or at least recommendations for her.
TIA,
Jan Ellen Brown RDH IBCLC
In soggy Charlotte, NC USA
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