Re: Reglan and breast milk
From: Meenan, Anna (annam@uic.edu)
Fri Jun 8 19:25:32 2007
I did. The FDA took an INTRAVENOUS preparation off the market years
ago because it caused arrhythmias in chemotherapy patients who were
given the drug for nausea and vomiting. Oral doses of 80 mg/day or
less (Dr Hale recommends 10-20 mg 3-4Xdaily) have never been
associated with arrhythmias in healthy breastfeeding women or their
babies. There have been folks who have recommended p.o. doses higher
than that, but Dr Hale does not. There is actually quite a bit of
evidence for the efficacy of metaclopramide. See bibliography of the
metaclopramide chapter in Medication and Mother's Milk 2006. It will
not help in women with normal prolactin levels though, which may be
why some are not impressed with it.
Anna Meenan MD
>consider doing a google for fda and domperidone. Several reports of
>cardiac arrest and irregular heart beats. FDA specifically warns
>against use and importing. Evidence for any significant effect of
>Reglan is weak. See paper in premies by Wendy Hansen when she was
>here at Iowa. Not definitive but some food for thought.
>
>________________________________
>
>________________________________
>From: ob-gyn-l@obgyn.net on behalf of Henry Gregor
>Sent: Wed 6/6/2007 3:41 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Reglan and breast milk
>
>Thanks Anna. I should have thought immediately of Dr. Hale...was
>looking at from the lactation milk production physiology view and
>not thinking of it from the use of meds in pregnant and lactating
>women point of view....the list proves its value once again, hehe.
>
>Hank
>
>"Meenan, Anna" <annam@uic.edu> wrote:
>
> Just attended a lecture by Dr. Thomas Hale (author of
>Medications and Mothers Milk) last night. He recommends 10-15 mg
>TID and should see a response in 24-48 hours. He recommends
>checking a prolactin level, as if it is over 200, the Reglan will
>not work. I would draw prolactin level, start metoclopramide at
>10TID, increase to 15 TID if no response in 2 days. If your
>prolactin comes back at over 200 ng'ML, and the med isn't helping,
>D/C it.
>
> Be careful with metoclopramide. As many as 50% of moms who
>take it for more than 4 weeks will get depressed. An alternative is
>Domperidone, 20 mg tid, which is not available in the US, but can be
>made in a good compounding pharmacy or obtained with a scrip sent to
>a Canadian pharmacy. All the benefits without the side effects.
>
> Also, if you do use metoclopramide. taper it by 10 mg q week.
>Don't stop abruptly.
>
> Anna Meenan, MD
>
> In the past I've prescribed reglan to help improve
>milk flow...have done that only rarely and so long ago, I can't
>remember what dosage/interval I used...would also wonder if others
>have used this successfully? Patient has tried all the usual
>measures re increasing production. Thanks for any input.
>
> Hank
>
>________________________________
>
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