Is metoclopramide (Metoclopramide) safe during breastfeeding?

From the Guidelines

Metoclopramide is safe to use during breastfeeding and may even increase milk supply. According to the guideline on anaesthesia and sedation in breastfeeding women 2020 from the Association of Anaesthetists 1, metoclopramide can be used in lactating women. The study notes that metoclopramide is also used as a galactagogue, which means it may increase milk supply.

Key Points to Consider

• Metoclopramide can be prescribed at doses of 10-15 mg three times daily for mothers who need to increase their milk supply or to treat nausea, vomiting, or gastroesophageal reflux.
• Only small amounts of the medication pass into breast milk, and it has not been shown to cause harm to nursing infants.
• Treatment duration should typically be limited to 2-3 weeks when used as a galactagogue to minimize the risk of side effects.
• Mothers should be aware of potential side effects including drowsiness, restlessness, and rarely, extrapyramidal symptoms (like muscle spasms or tremors).
• If these occur, the medication should be discontinued.
• Metoclopramide should be used only after non-pharmacological methods to increase milk supply have been tried, such as increased breastfeeding frequency, proper latch techniques, and adequate hydration and nutrition.

Comparison with Other Medications

Other medications mentioned in the guideline, such as domperidone, also have low levels in milk due to first-pass hepatic and intestinal metabolism 1. However, metoclopramide is specifically noted for its potential to increase milk supply, making it a beneficial option for mothers struggling with low milk supply.

Clinical Decision Making

In clinical practice, metoclopramide can be a useful option for lactating women who need to increase their milk supply or manage nausea and vomiting. As with any medication, it is essential to weigh the potential benefits against the potential risks and to monitor for side effects. The guideline from the Association of Anaesthetists 1 provides valuable guidance for healthcare providers making decisions about medication use in breastfeeding women.

From the FDA Drug Label

Metoclopramide is passed into human milk and may harm your baby Talk with your doctor about the best way to feed your baby if you take metoclopramide.

Metoclopramide use in breastfeeding is cautioned as it is excreted in human milk and may harm the baby. It is recommended to discuss with a doctor the best way to feed the baby if metoclopramide is taken 2.

From the Research

Metoclopramide in Breastfeeding

• Metoclopramide is a medication that has been used to increase milk production in breastfeeding women 3, 4, 5, 6, 7.
• However, the evidence on its effectiveness is mixed, with some studies showing no significant increase in milk volume 3, 7 and others showing a small increase 5.
• A systematic review and meta-analysis found that metoclopramide did not increase milk volume in lactating women, but did increase serum concentrations of prolactin 7.
• Another study found that domperidone was more effective than metoclopramide in increasing milk production in mothers of preterm infants 3, 6.
• The safety of metoclopramide in breastfeeding women has been evaluated, with no significant adverse events reported in some studies 5, 7, but a black box warning for potential serious side effects has been noted in others 4.

Comparison with Domperidone

• Domperidone has been shown to be more effective than metoclopramide in increasing milk production in mothers of preterm infants 3, 6.
• A Bayesian network meta-analysis found that domperidone increased daily breast milk volume in mothers of preterm infants, without serious adverse events 6.
• However, the difference in milk output between domperidone and metoclopramide was not significant in another study 5.

Safety and Adverse Events

• Metoclopramide has been associated with potential serious side effects, including a black box warning 4.
• However, no significant adverse events were reported in some studies 5, 7.
• The frequency of maternal drug-related adverse outcomes was not different among domperidone, metoclopramide, and placebo in another study 6.