Is Metoclopramide safe while breastfeeding?
Here is what NIH LactMed, the U.S. National Library of Medicine's authority on medicines and breastfeeding, reports about Metoclopramide. This is a summary of that source — not our own verdict.
Effects on the breastfed infant
In an early report, 5 infants were nursed during 7 to 10 days of maternal metoclopramide therapy at a dosage of 10 mg orally 3 times daily. No adverse effects were noted.[ 23 ] In a placebo-controlled study of the effect of metoclopramide on milk production in 37 women, an infant whose mother was taking oral metoclopramide 15 mg 3 times daily reportedly had intestinal discomfort. No infants whose mothers were taking a dosage of 5 or 10 mg 3 times daily or placebo had any adverse effects. Metoclopramide was possibly the cause of the adverse reaction.[ 12 ] Seventeen mothers with poor lactation were treated with oral metoclopramide 10 mg 3 times daily for 3 weeks. One mother reported that she and her infant had increased intestinal gas formation during treatment. Metoclopramide was possibly the cause of the adverse reaction.[ 13 ] Thirty-two mothers with complete or partial lactation failure were given oral metoclopramide 10 mg 3 times daily for 10 days and advised to nurse every 3 hours. None of the mothers reported adverse effects in their infants.[ 24 ] Twenty-three premature infants whose mothers were having difficulty maintaining milk production had steady weight gain and no adverse effects related to feeding tolerance or stool frequency during maternal metoclopramide therapy. The mothers were taking oral metoclopramide 10 mg 3 times daily for 7 days, with a tapering dosage for 2 more days, beginning at an average of 32 days postpartum.[ 25 ] Thirteen women with insufficient milk production who were 4 to 20 weeks postpartum were randomized to receive metoclopramide or placebo 10 mg orally 3 times daily. The average plasma prolactin levels before therapy and after 3 weeks of maternal therapy were no different in the infants of women who received metoclopramide or placebo.[ 26 ] Eleven breastfed infants whose mothers were given oral metoclopramide 10 mg 3 times daily for 5 days beginning on day 1 postpartum were compared to the infants of 11 matched mothers who rec
Effects on milk supply
Metoclopramide increases serum prolactin in lactating and nonlactating women.[ 3 , 29 , 30 ] This effect is thought to be caused by the drug's antidopaminergic effect. Galactorrhea has been reported after long-term use of metoclopramide for nausea associated with migraine. The patient was taking 10 to 40 mg 1 to 4 times weekly for about 4 months.[ 31 ] Other cases of galactorrhea have been reported in nonpregnant, nonlactating women after 2 to 5 days of treatment with normal or slightly low serum prolactin levels.[ 32 , 33 ] Numerous papers have reported studies that used metoclopramide to increase milk production. All studies were small with 40 or fewer patients. Most of the studies have designs that would not be considered valid using today's standards of evidence-based medicine. Many of the studies had no placebo control;[ 13 , 18 , 24 , 25 , 27 , 34 - 36 ] only 7 studies employed randomization;[ 12 , 17 , 20 , 26 , 37 - 39 ] and only 2 studies were clearly and adequately blinded.[ 20 , 37 ] The studies that meet or come close to meeting current evidence-based medicine standards are described in more detail below. In one early double-blind study, 20 women who had undergone delivery by emergency or elective cesarean section were randomized to take oral metoclopramide 10 mg 3 times daily (n=10) or placebo for 7 days (n=10) beginning on the first day after cesarean section.[ 17 ] All mothers expressed a desire to breastfeed their infants for at least 3 months and received daily visits by an investigator to discuss breastfeeding problems and were given advice and encouragement to breastfeed. The mothers in the 2 groups were closely matched except that 3 preterm infants in the metoclopramide group were separated from their mothers in the intensive care unit and were nursed there initially and fed expressed milk until discharge. At 10 days postpartum, there were no differences in the number of infants being breastfed in each group; at 6 weeks postpartum, 9 women were b
Levels in milk
Maternal Levels. Ten mothers who were 7 to 10 days postpartum were given a single oral dose of metoclopramide 10 mg. Two hours after the dose, the average milk level was 126 mcg/L. The authors estimated that a fully breastfed infant would receive a maximum daily dosage of 45 mcg/kg.[ 17 ] Five mothers took metoclopramide 10 mg orally 3 times daily beginning on day 3 to 9 postpartum because of an insufficient milk supply. Metoclopramide in milk samples taken 1 to 2 hours after a 10 mg dose on days 4 and/or 14 ranged from 52 to 157 mcg/L. The authors estimated that these infants would receive maximum metoclopramide dosages of 6 to 24 mcg/kg daily. The same paper reported on 18 women who received metoclopramide 10 mg orally 3 times daily beginning in week 8 to 12 postpartum. Milk levels measured once on the morning of day 9 to 11 of therapy averaged 48 mcg/L (range 21 to 125 mcg/L). The authors estimated that these infants would receive maximum metoclopramide dosages averaging 5.2 mcg/kg (range 0.8 to 13.2 mcg/kg) daily.[ 18 ] This latter group of infants would receive about 1% of the maternal weight-adjusted dosage. Seventeen women who were part of a study of metoclopramide for enhancing lactation in mothers of premature infants had complete 24-hour milk samples measured for metoclopramide. The dosage was 10 mg orally 3 times daily and milk samples were collected between day 6 and 14 of therapy. Three of the mothers had no measurable metoclopramide in milk. The other 14 mothers had metoclopramide milk levels averaging 45 mcg/L. The authors calculated that a fully breastfed infant would receive 11 mcg/kg daily.[ 19 , 20 ] This corresponds to about 2% of the maternal weight-adjusted dosage and 7 to 11% of a dose for preterm infants.[ 21 ] Infant Levels. Five breastfed infants were studied whose mothers were taking metoclopramide 10 mg orally 3 times daily beginning on the day 3 to 9 postpartum because of an insufficient milk supply. Serum metoclopramide levels were unde
Source: NIH LactMed (National Library of Medicine).
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.