Pamela writes:
"If we are looking at risk/benefit
ratios, surely breastmilk laced with a little metoclopramide or sulpiride is
infinitely preferable to the use of formula when lactation needs a little
boost?"

The caution doesn't have to do with baby, but with mother.  One of the
major side effects of this medication is depression.  There is always the
caution that it is contraindicated in mothers with a history of depression.
 However I know of two women who had NO history of depression who became
clinically depressed while taking the drug. I think that with the high
incidence of PPD we need to be most careful when prescribing for a new
mother a medication with a high incidence of depression as a side effect
even if it is temporarily effective in increasing a milk supply. It has
been pointed out frequently on Lactnet that when a mother stops the med.
her supply usually drops, even if the med. is gradually eliminated, so to
remain effective most must continue on the drug.

Two mothers may not seem like many to you who are fond of the drug for
increasing a milk supply and who probably have had success with its use,
but I fear that, in our eagerness to find a quick solution to the serious
problem of low milk supply, we may dismiss the incidence of depression as a
side effect. I don't have professional experience with the drug in my
practice because I never recommend it.

In one of the cases that I am familiar with (not my client), after a nice
maternity leave, Mom returned to work, and when her milk supply wasn't
keeping up with her baby's needs  (at about 3 months)she was given Reglan.
The LC told her to ask her co-workers and family to look out for mood or
personality changes.  Her milk supply was certainly boosted, but at about 2
weeks on the drug she began to feel anxious and "edgy" and easily upset.
When her husband mentioned the medication she just got angry at him for not
being supportive of all that she was doing. Her work setting was rather
good, as she liked her job of teacher, and her baby was in the day care
that is a part of the school, but her emotional health continued to worsen.

Three weeks later she was in the psychiatric hospital where she stayed for
2+ weeks, after which she was on antidepressant meds for a year, gradually
tapering off.  Of course her baby was weaned when she entered the hospital
and never returned to the breast.

"What could she have done?" you may ask.  Several alternatives appear
better than what she did do. I, too, wish that there were a "safe"
medication that I could suggest that would have a quick response in my
clients.

The second woman wasn't hospitalized but her depression and anxiety were
severe and she was certain that it was related to the drug.  I want to help
mothers with their supply as much as the rest of you do but, in my opinion,
Reglan carries too great a risk. Most LCs (some highly respected ones) have
a favorable opinion of the drug but I think that we need to continue to
push for domperidone since it seems to carry far less severe side effects.

And my clients are given the "suggestion" of fenugreek and More Milk, both
of which I have good success with.  There has been only the side effect of
occasional (2 cases) of diarrhea with fenugreek and the diabetic mother who
took it just monitored her blood sugars, which she was doing anyway.

There were several posts in the past couple of months on the health risks
to women who take Reglan postpartum.  If you do a search for "reglan in
lactnet since sept 98" you will get some other views.

I just did a search of all of Lactnet for 97/98 and came up with 199
matches.  In reading through the summaries, I came to one in which the
poster said that the mom had been taking fenugreek and blessed thistle but
it was discontinued because the hospital staff were uncomfortable with
herbs, and the mom was given Reglan. (With which they were more
comfortable, of course.)

Well, there you have my opinion on this topic.  Others who have had success
with the drug and no adverse effects will surely post here and everyone can
make up her own mind.

Patricia Gima, IBCLC
Milwaukee, Wisconsin, Upper Midwest USA

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