Reglan (generic name Metoclopramide) and Domperidone (generic name Motilium) are two prescription drugs used for increasing milk supply. Both drugs are prescribed to treat gastroesophageal reflux (GERD) and nausea, but they have another documented effect (called an off-label use) as Galactogogues—a term in the lactation world for any drug or herb that increases a mother’s milk supply. Reglan and Domperidone increase the amount of milk a mother produces because they inhibit dopamine levels. Dopamine is the major inhibitor of prolactin, a hormone secreted from the brain that is necessary for milk production. REGLAN Reglan is readily available, requires a prescription, and is FDA-approved. The recommended dose is 10 mg taken three times per day. Milk supply generally begins to increase within four days of starting the medication, but if there is no change after seven days, Reglan will probably be ineffective. Reglan crosses the blood brain barrier, and while most women using the medication will experience few side-effects—such as dizziness or fatigue— using Reglan for longer than three weeks can trigger severe depression. Mothers with a history of depression should therefore not use the drug at all. Reglan is often used to treat reflux in pre-term infants and babies and does not appear to have any concerning side effects for a baby. It is recommended that women who do experience an increase in milk supply begin weaning off the drug after the second week, decreasing the dosage by one pill, every other day. If the milk supply decreases, mothers should consider taking Domperidone instead. DOMPERIDONE Domperidone is popular in Canada, Australia, New Zealand, Mexico, and other areas of the world, and is over- the-counter in many countries. Because it does not cross the blood brain barrier, Domperidone can be used long- term without triggering depression. The amount of drug secreted in the breast milk is so small that side-effects to the infant are rare. Very uncommon but possible side-effects for the mother include dry mouth, headaches, and abdominal cramps. Domperidone is not FDA-approved, so your physician may be reluctant to write a prescription for it. Although Domperidone is not FDA-approved, the American Academy of Pediatrics has approved it for breastfeeding mothers. Thomas Hale, Ph.D., author of Medications and Mothers’ Milk, categorizes Domperidone as an L1 drug (safest in lactation). The recommended dosage for Domperidone is 20 mg taken four times per day. Many mothers note a positive result within three to four days; however, it may take two to three weeks to achieve the maximum effect. As with Reglan, mothers should try weaning off the drug once the milk supply has increased. If the milk supply falls, unlike Reglan, Domperidone can still be safely taken for many months. In order to fill your prescription for Domperidone, you will need to go to a compounding pharmacy. One source is RoxSan Compounding Pharmacy in Beverly Hills: (310) 273-1644. If you are unable to get a prescription from your physician, you can order Domperidone online at canadadrugsonline.com No part of this handout may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, without permission in writing from The Pump Station & Nurtury™. This article has not been prepared by a physician, is not intended as medical advice, and is not a substitute for regular medical care. Consult with a physician if medical symptoms or problems occur.
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