I have left off using metoclopramide because domperidone causes so many
fewer side effects.  This is an option, as a Canadian physician, which I
have.  If I had no option, I might use metoclopramide, because not all
mothers got side effects.  Some did, but not a majority. But they were
fairly distressing--tremors, irritability, sleepiness, often all at the
same time.

I use the dose of tincture of blessed thistle mentioned in Susun S.
Weed's (suspicious name) Wise Woman Herbal for the Childbearing Years.
She recommends 20 drops three or four times a day.  In the section of
her book, I do not remember anything about fenugreek.  I use 2 capsules
or pills three times a day to start, and possibly increasing to 3 three
times a day.  Only one woman, that I know of, who has taken this dose
got diarrhea.  The fenugreek seems to come as a standard sized pill.
Some of the parents have gotten capsules of blessed thistle.  I don't
know if this works as well.  I have taken the dose of fenugreek, partly
from Lactnet, partly from the response the mothers have gotten.

Jack Newman, MD, FRCPC