Helen,

I can confirm what Karleen and Jean say.  Sulpiride was very commonly 
used as a galactogogue in Southern Africa.  It's actually a mild 
antidepressant, and a psycho-normaliser as well as an antipsychotic, 
and works by increasing prolactin levels (the hormone we all produce 
when stressed!).  It is not indicated for increasing breastmilk 
production, but the doctors, OBs and paeds in Zimbabwe knew that it 
worked for this purpose and prescribed it a lot.  I did a mini-survey 
once of my own clients, and found that a full 23% of them had been 
prescribed this drug either in the current or a previous 
lactation.  So I've worked with literally hundreds of women who took 
it. I did find that it was rather over-used by the doctors to "fix" 
almost any breastfeeding problem where the mother might be concerned 
whether she was making enough milk, and often without a proper 
investigation of the cause of low milk supply, and it was usually 
prescribed for two weeks and then abruptly discontinued.  It seemed 
to take about 4 days to start working, when the mother would then 
happily notice an increase in breastmilk production.  However, at the 
end of the 2 weeks, sudden withdrawal caused a sharp _drop_ in 
supply, again about 4 days after the last dose.  The mothers would 
become very discouraged at that point, thinking that even sulpiride 
didn't help them.

However, I found this drug amazingly effective if the original cause 
of not-enough-milk was addressed (ineffective breastfeeding by the 
baby, stringing the feeding times out by the mother) and if the 
mother was willing to take other measures to increase her milk 
production as well (breastfeeding much more often, expressing the 
milk left behind at the end of feeding and using this as a top-up for 
the baby).  The doctors were willing to prescribe a second or third 
course, and some mothers took it for months. Once the breastfeeding 
was going well and the baby was gaining weight appropriately I found 
it helpful to suggest that the mother ask her doctor if he would 
agree to tapering off gradually, reducing from 3 x 50 mg/24 hours, to 
twice, then to once, before stopping altogether.  I did find that 
some mothers became psychologically hooked on it, and I used to 
address this with lots of hand-holding and confidence building as the 
mother stopped taking it, but I don't believe that there is any 
possibility of physical addiction.

Sulpiride was so well known that nearly all the mothers I worked with 
knew about it, and would cadge pills from their friends, who would 
gladly share it - which was disastrous.  Consequently I eventually 
developed a handout outlining what I observed, to give to all my 
clients who had been prescribed sulpiride, in the hope that they 
wouldn't pop pills on a bad day and take none on a good day, or hand 
them out to their sisters/friends/cousins... and with the caution 
that they should always seek medical advice before changing the way 
they took this medication.  I kept in touch with the doctors too, of 
course, and shared my observations with them.   Let me know if you 
want a copy.  As I say, I found sulpiride to be a  really useful 
medication for  increasing  breastmilk production.  The other usual 
methods will work too, of course, and most often it's _not_ 
needed.  But when a situation is quite fraught then I found that 
sulpiride gives _quicker_ results.  I found that in cases of 
inadequate glandular tissue or - say - post-partum haemorrhage - 
sulpiride was not enough to bring in a full milk supply - but what it 
did seem to do was to maximize production of what little milk was 
being produced.  It also kept the mother feeling calm and encouraged 
and hopeful during a difficult situation - because it's a mild 
antidepressant.  It was also extremely useful for a mother inducing 
lactation from scratch (adoptive nursing) or relactating after an 
interval of a few days to a few months.

I know  this drug is not used in the UK or the US for help with 
lactation, and there is a lot of concern about it, as Karleen 
reflects.  But because it was so very commonly prescribed to my 
clients, with babies of all ages, including pre-term babies, and 
because it worked so well and seemed to cause no side-effects that I 
heard reported, then I can't really understand the paranoia about 
it.     If your client's medical advisors have any colleagues in 
Southern Africa, it might be worth making the gentle suggestion that 
they might consider obtaining their opinion and reassurance.

Pamela Morrison IBCLC
Rustington, England
--------------------------------------------
Subject: Non-domperidon prolactine stimulation?
From: [log in to unmask]
Date: 06/01/2010 2:12 pm

Hi,

Case: a mother who is looking for information how to stimulate her 
milk production, but
without using domperidon. She gave me permission to post her question here.

Mother has hypoplastic tubular breasts and went through quite some 
trouble to nurse her first
3 children. She used high doses of domperidon and needed about 300 ml 
donormilk in a
SNS to feed her children adequately. Baby would lose interest in 
breast if she didn't
supplement with SNS because of low milkflow.

She is planning to try to conceive later this year and is not looking 
forward to using
domperidon again because it makes her hungry all the time and she 
gains lots of weight as
well (from eating more).

She is wondering if there is another way to stimulate prolactine, 
apart from domperidon.

--
Heleen Hayes, http://www.xs4all.nl/~hhayes
---------------------------
But Karleen says, "There's a load of drugs that increase prolactin 
secretion but many of them are drugs for psychiatric conditions and I 
wouldn't been keen on taking
them!  There's a drug commonly used in Africa- can't remember the 
name off the top  of my head but I'm sure that one of our African 
Lactnetter will supply it."
Karleen Gribble
Australia


And Jean says, " The most common drug (mis)used in South Africa to 
enhance lactation is  supiride (an anti-psychotic).  Metaclopramide 
is also used."
Jean Ridler  RN  RM  IBCLC
South Africa   [log in to unmask] 

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