With good breastfeeding habits and techniques mom is usually able to produce more than adequate amounts of breast milk. There are, although, occasions when she will need to turn to medications to improve milk production and it is important that she understand the benefits and potential problems which have been associated with them.
Reglan (Metoclopramide) Increases Prolactin Hormone that Stimulates Breast Milk
Reglan (Metoclopramide) is a medication specifically used for stomach problems. It definitely increases prolactin, the hormone which stimulates breast milk production and is often used off label, but the actual effect on improving the amount of breast milk production is not consistent. Reglan is recommended at low dosages. The dose typically used is 10 mg 3 times daily. Reglan in low doses greatly reduces the possibility of side effects. Although uncommon, it can exacerbate depression, especially in moms with a tendency for depression, cause low energy and dry mouth and may lead to stomach upset and headaches. Significant, involuntary facial muscle contraction is a major concern with long-term use of Reglan. For this reason Reglan is typically used for only 1-2 weeks.
Domperidone (Motilium) is a medication that is not available in the U.S. and can only be purchased through Canada. The medication is specifically used for stomach problems as well, but has been used off-label by thousands of breastfeeding mothers to increase milk production.
The medication increases prolactin, which in turn stimulates milk production. It has been shown to work better than Reglan. It can potentially cause the same side effects as Reglan. It has been successfully used by thousands of breastfeeding mothers in Canada over the past 30 years with no significant side effects. Several years ago when elderly patients were given extremely large doses, a small number developed life threatening heart beat irregularities, so in 2004, because of an over abundance of caution, our US FDA banned the use of the medication and does not recommend it be used off label for breast feeding.
For more than 20 years tens of thousands of patients in Canada have successfully used lower dose (30-60 mg/day) Domperidone without problems and the FDA is being petitioned again to accept its use in low doses. Because of the rare problems associated with larger doses Domperidone should be used in the smallest dosages possible. We have attached some reference articles on the safety of Domperidone. Because of medical legal reasons and the FDA’s position we do ask that our patients sign an informed consent disclosure.