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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