I have some thoughts on the use of Reglan/metoclopramide, since this is within the realm of the adoptive nursing crowd!  We haven't seen many moms using Reglan since we've had resources for getting domperidone from other countries but, prior to about 4 or 5 years ago, many adoptive moms had tried it.  Almost everyone had side-effects that they felt were significant enough that they decided to get off of it, despite seeing some increase in milk production.  This is significant, because adoptive moms can sometimes feel pretty desperate to increase their milk production, and be willing to go through some pain to do so.  The most common effect was depression, but some have had severe anxiety, or a combination.  A few moms I know, who stayed on it for several months, required extensive psychiatric treatment to get over the effects of it.  At one time, I just suggested that no one with any history of clinical depression should try it, until a mom who in her 40s and had no history of clinical depression at all, had a severe reaction that took her nearly a year to get over the effects of.  When I met someone who had ended up in an emergency room because she was trying to harm herself, I started telling adoptive moms to stay away from it.  This poor mom had even asked the doctor who prescribed it for her, if it could be causing her increasing depression and anxiety, and was assured that it was not, and that she needed to keep taking it.  The psychiatrist who treated her for drug-induced psychosis, however, had no doubt that it was the Reglan.  

There doesn't appear to be any way to predict who will have problems with it.  Most ladies have problems in the first few days of taking it.  Some can take it for a while, seemingly without a problem, and then have it hit them, and others have minimum effects, until they get off of it, and have a rebound effect.  The longer they have been on it, the longer it tends to take to recover from the the effects of it.  Personally, I had some pretty serious effects from taking it, the time I stayed on it for several weeks.  I tried taking it several different times, while nursing my fourth and fifth adopted babies, hoping that I could keep the symptoms under control, but could never stay on it.  It was a shame, because I could see an increase in milk production, and the effects were almost immediate.   

I know that Reglan has been used successfully in moms who have given birth to their babies,  without as high a rate of side-effects as adoptive moms.  I wonder if part of it has to do with a difference in the overall hormonal balance of someone who has recently been through a pregnancy, versus someone who has not.  Perhaps the length of time between delivery and starting the Reglan makes a difference.  

Darillyn

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