Metoclopramide is a gastrointestinal stimulant that is commonly used for gastroesophageal reflux related to reduced gastric tone in both adults and children. It also has been found to stimulate prolactin release by blocking dopamine from inhibiting the production of prolactin, and so has been used “off-label” to increase milk production. Clinical studies have shown that metoclopramide can increase milk production an average of 66 to 100 percent, and it has been used to help increase milk production in North America for more than two decades.(1), (2), (3), (4), (5), (6), (7) The effects of metoclopramide have been found to be dose-related; the right amount is necessary for a good result. Metoclopramide is transferred into human milk in an amount that is substantially less (1-5 percent) than the dose which is commonly prescribed to treat gastrointestinal distress in an infant.(8)
One concern with metoclopramide is its ability to penetrate the blood-brain barrier, which can result in central nervous system side-effects such as depression and involuntary body movements (dystonia), especially with longer term use.(9), (10), (11) Such side-effects are considered uncommon for non-breastfeeding uses, but informal reports from lactation specialists and physicians suggest that postpartum women may be more vulnerable, and one study recently theorized that women in general may be more susceptible to such negative effects.(12) Another case report raised concerns for combining metoclopramide with the new generation SSRI (Selective Serotonin Reuptake Inhibitors) anti-depressants.(13) Women who have a personal or family history of depression should avoid using metoclopramide. The American Academy of Pediatrics considers it a “drug whose effect on nursing infants is unknown but may be of concern,” and pharmacology expert Tom Hale has rated it L2 (safer).(14) (Hale uses a five-point lactation rating system: L1- Safest; L2- Safer; L3- Moderately Safe; L4- Possibly hazardous; L5- Contraindicated.)
(1) Gabay, M. Galactogogues: medications that induce lactation. J Hum Lact 2002 Aug; 18(3):274-9.
(2) Budd, S., Erdman, S., Long, D., et al. Improved lactation with metoclopramide: a case report. Clin Pediatr 1993; 32:53.
(3) Ehrenkrantz, R. and B. Ackerman. Metoclopramide effect on faltering milk production by mothers of premature infants. Pediatric 1986; 78:614.
(4) Gupta, A. and P. Gupta. Metoclopramide as a lactogogue. Clin Pediatr 1985; 24(5):269-272.
(5) McNeilly, A., Thorner, M., Volans, G., et al. Metoclopramide and prolactin. Br Med J 1974; 2:729.
(6) De Gezelle, H., Ooghe, W., Thiery, M., et al. Metoclopramide and breast milk. Eur J Obstet Gynecol Reprod Biol Apr 1983; 15(1):31-36.
(7) Kauppila, A., Kivinen, S., Ylikorkala, O. Metoclopramide increases prolactin release and milk secretion in puerperium without stimulating the secretion of thyrotropin and thyroid hormones. J Clin Endocrinol Metab 1981 Mar; 52(3):436-9.
(8) Hale, T. Medications and Mothers’ Milk, 11 th edition. Amarillo, TX: Pharmasoft Publishing, 2004; 548-551.
(9) Anfinson, T. Akathisia, panic, agoraphobia, and major depression following brief exposure to metoclopramide. Psychopharmacol Bull 2002 Winter; 36(1):82-93.
(10) Feillet, N., Nguyen, L., Caillaud, D. Metaclopramide and depression: apropos of a case of a pregnant women. Therapie 1996 Sep-Oct; 51(5):600-1.
(11) Patterson, D., Abell, T., Rothstein, R., et al. A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis. Am J Gastroenterol 1999 May; 94(5):1230-4.
(12) Rodgers, C. Extrapyramidal side effects of antiemetics presenting as psychiatric illness. Gen Hosp Psychiatry 1992 May; 14(3):192-5.
(13) Fisher, A. and M. Davis. Serotonin syndrome caused by selective serotonin reuptake-inhibitors-metoclopramide interaction. Ann Pharmacother 2002 Jan; 36(1):67-71.
(14) Hale, T. Medications and Mothers’ Milk. Amarillo, TX: Pharmasoft Publishing, 2004; 548-551.