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Prescription drugs used for increasing milk supply

By Kelly Bonyata, IBCLC

There are several prescription drugs that have been used to increase milk supply: Metoclopramide (Reglan), Domperidone (Motilium), and sulpiride (Eglonyl, Dolmatil, Sulpitil, Sulparex, Equemote).

The presence of an appropriate level of the hormone prolactin permits lactation to proceed normally. When a mother has low prolactin levels, milk supply may be affected. Prolactin levels are primarily regulated by inhibition: the presence of prolactin-inhibiting factors (dopamine is the principal one) keep prolactin levels in check. The drugs used for increasing milk supply work by blocking dopamine, which results in an increase in prolactin levels. These drugs do not work in all women and would not be expected to increase milk production in a woman who already has normal (high) prolactin levels.

Reglan has often been used in the U.S.. One major side-effect of Reglan is severe depression; it is contraindicated in moms with a history of depression, and all moms who take this should keep an eye out for signs of depression. One of my sources advises all adoptive mothers to stay away from Reglan, since it has caused serious depression/anxiety in moms regardless of previous history. This depression side effect usually develops over 3-4 weeks, and goes away if mom discontinues the Reglan. Other side effects include diarrhea, sedation, gastric upset, nausea, seizures and extrapyramidal effects (twitching, etc.)

Domperidone has been used successfully in Canada and other areas of the world, and has significantly fewer side effects than Reglan. It has been approved by the American Academy of Pediatrics for use in breastfeeding mothers, and has been given Lactation Risk Category L1 ("safest") in the 2004 edition of Medications and Mothers' Milk. It is not widely available in the U.S. - you may be able to get a compounding pharmacy to make it for you if your doctor prescribes it, or may also be able to order it from Canada or other countries). See the links below for more info.

Sulpiride is commonly used in various countries including Zimbabwe, South Africa and Chile. The primary use for sulpiride is for schizophrenia (it is an antipsychotic and antidepressant), but it also increases serum prolactin levels and thus can enhance breast milk yield.

Prescription drugs that stimulate lactation
Name of medication
AAP approved?*
Domperidone (Motilium, Motilidone)
yes
L1 (safest)
Metoclopramide (Reglan)†
no
L2 (safer)
Sulpiride (Dolmatil, Sulparex, Sulpitil, Eglonyl, Equemote)
not reviewed
L2 (safer)

*  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
** Per Medications' and Mothers' Milk by Thomas Hale, PhD (2004 edition)
† Per the AAP, classified as "Drug whose effect on nursing infants is unknown but may be of concern." AAP notes on this drug: "reported or possible effect: none described; dopaminergic blocking agent"; "Drug is concentrated in human milk relative to simultaneous maternal plasma concentrations." Hale reports results of a number of studies and indicates that domperidone is preferred but not available in the US. He notes that no pediatric concerns have been reported via milk, and that this drug is commonly used in pediatrics.

 

Additional information

Motilium (Domperidone) | Reglan (Metoclopramide)

Motilium (Domperidone)

 

Reglan (Metoclopramide)

"I just thought I would let you know about a very serious side effect related to the use of Reglan... I wanted to share my experience with the hope of warning any unsuspecting women of this possible nasty side effect.

"First, you should know that I am a lactation consultant, I recently gave birth to my fourth child and despite my training and knowledge, I was in need of a galactogogue. I opted for Reglan upon consultation with my physician and despite a history of mild depression.

"After taking the medication for approximately 6 weeks, I decided it was time to taper off of the medication. Within 48 hours of my last dose, I began to suffer from severe anxiety and eventually even had one panic attack. I have never had any problems with, or history of anxiety or panic attacks in my life and as the result of an in-depth assessment by an anxiety disorder specialist, it was determined that this development was directly related to my use of Reglan.

"This experience was absolutely horrible! I was bed ridden for 10 days and it took a total of three weeks for me to recover completely. Subsequently, my milk supply suffered substantially from the physical insult. I have since, however, been able to recover it partially only after arduous pumping and retraining of my baby to take the breast once again.

"As a lactation consultant, I will be happy to educate my clients on the use of this drug, but I will never again recommend it myself."

--Laura

 

Page last modified: 06/06/2006
Written: 05/12/98

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