Working in a hospital environment with preemies both inpatient and out, we 
use reglan all the time.  It almost always works unless the mother is too far 
postpartum or she did not experience breast growth during pregnancy or has some 
other hormal problem.  In my experience reglan makes about 1-2 per 10 
faitgued, emotional, etc.   We don't use domperidone as much but I have yet to have a 
mom with a side effect.  If domperidone was more readily available we would 
use it first line.  Unless the mother has an unacceptable psychiatric history  
(not just a little emotional, sad or depressed but a history of 
self-mutilation, suicide attempts, bipolar or currently suicidal) the risks invariably 
outweigh the risks for the infant. I personally almost always give it a month at a 
time 10mg tid. Usually starting with a two day taper up and a weekly taper down 
by one tab per week once a full milk supply has been attained.   Hale has 
some good info on these meds.  Their is also the following articles/sources to 
review: 
Gabay MP, Galactogogues: Medications that induce lactation.  J Hum Lact 
2002;18(3):274-279. 
Hale TW: “Medications in Mothers’ Milk, ed 10, Amarillo: Pharmasoft , 2002. 
Lawrence RA. Lawrence RM. Breastfeeding: A Guide for the Medical Profession, 
5th edition. St. Louis: Mosby, 1999.
Kauppila A, Kivinen S, Ylikorkala O. A dose response relation between 
improved lactation and metoclopramide. The Lancet 1981;1:1175-77.
Gupta AP, Gupta PK: Metoclopramide as a lactagogue. Clin Pediatrics 
1985;24:269-72.
Betzold CM. Special Populations: Pregnancy and Nursing Mothers. In:  Edmunds, 
MW and Mayhew MS, editors. Pharmacology for Primary Care Providers, (ed 2). 
St. Louis: Elsevier Science; 2004.[In press]. 
Chris


Christine Betzold NP IBCLC MSN

www.theBFclinic.com

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