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] ______________________________________________________ Get Your Private, Free Email at http://www.hotmail.com