Lactnet,
I see in Hale's book that long term use >2wks is generally not
recommended. However, I was asked by a coworker to post this to lactnet:
when the client tapered off the metoclopramide, her supply dropped from
2 oz each pumping to 1/2 oz.  Can she go back on the drug? She was on
the fairly long term tapering regime, I think something like 10 mg tid x
7days, then 10 mg bid x 7 days, then 10 mg qd x 7 or 14 days (not sure
exactly).
The history is postpartum hemorrhage, hypovolemic shock, blood
transfusion, and at few weeks put on combination oral contraceptive
pills too. When she came to us from another hosp, I think around 10 wks,
with low supply and very slow gaining baby, she started formula in SNS,
co-sleeping, massage and pumping, and fenugreek/blessed thistle ala Dr.
Jack's handout. She consulted her MD and was started on the
metoclopramide as above and discontinued the contraceptives. The baby is
gaining well now but supplementation has never been able to be stopped.
Milk transfer at best on test weights was 45 - 60 cc or so on several
occasions. No retained placenta. When she pumped (at work part time) she
got 2 oz max. Now that the metoclopramide is stopped she gets 1/2 oz.
She says the herbs are not taking up the slack. Another colleague at
another hosp has shared that some of her clients who are MDs in
residency, have gone back on the drug with 10 mg qd for several months
and are still on it. If their supply dwindles, they take 10 mg tid x 3
days, and if supply goes up then they go on the once a day routine. If
the supply does not go up with the 3day plan, then they return to the
full regime, and stay on the once a day for long term (many months).
What do you think of this? And what could we now offer our client??
If possible, cc to me (see address below) on Wed, 10/14 (US time) and I
will share the info with the mom on Thurs when I am at work. If you cc
to me I will assume I can share the info. Many thanks.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, USA
Southeastern USA
mailto:[log in to unmask]


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