Last update: Aug. 27, 2018

Metoclopramide

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

An antiemetic indicated in the prevention and treatment of nausea and vomiting from chemotherapy, radiotherapy or migraines.
Its use is authorized in pediatrics from one year of age.
Oral, iv or im administration every 8 hours.

It is excreted in milk in small quantities, much lower than the recommended dose in infants (Pistilli 2013, Gabay 2002, Kauppila 1983, Lewis 1980) and causes no adverse effects in infants (Ehrenkranz 1986, Kauppila 1981, Sousa 1975), except for occasional and mild intestinal discomfort (Zuppa 2010).

Several medical associationss and experts consider the use of this medication to be safe during breastfeeding (Reece 2017, Hale 2017 p641, Davanzo 2014, Worthington 2013, Rowe 2013, Pistilli 2013, Amir 2011, Lee 1993).

As it is a dopamine antagonist it increases the production of prolactin and milk, so it is widely used as a galactagogue (Brodribb 2018, Anderson 2013, Winterfeld 2012, Muresan 2011, Marasco 2008, Gabay 2002, Emery 1996, Nemba 1994, Ertl 1991, Gupta 1985, Gezelle 1983, Tolino 1981, Brouwers 1980, Sousa 1975) especially in mothers with premature babies admitted to neonatal units (Ingram 2012, Ehrenkranz 1986) and in cases of relactation and induced lactation (Bryant 2006, Biervliet 2001, Cheales 1999, Kramer 1995 , Budd 1993).

Metoclopramide does not alter the composition of milk (Ertl 1991), accelerates the change from colostrum to transition milk (de Gezelle 1983) and does not alter the secretion of thyroid hormones (Tolino 1981, Kauppila 1981).

Doses of 10 mg two to three times a day for 2 to 4 weeks increase milk production (Rowe 2013, Pistilli 2013, Ingram 2012, Zuppa 2010, WHO 2002, Ehrenkranz 1986, Kauppila 1985 and 1981, Guzmán 1979).

Some authors (Rowe 2013) suggest making a slow withdrawal, over several weeks to avoid production loss.

The galactagogue effect has not been demonstrated in other better designed studies (Sachs 2013, Fife 2011, Sakha 2008, Hansen 2005, Lewis 1980).

It can cause extrapyramidal effects and depression (Amir 2011, Marasco 2008, Quiel 1989), especially in high doses, prolonged use (more than one month) and especially if antidepressants are taken at the same time (Fisher 2002).

Domperidone has fewer neurological side effects.

The best galactagogue is effective counseling during pregnancy and after delivery to achieve frequent on-demand breastfeeding with correct technique in a self-confident mother (Brodribb 2018, Anderson 2013, Mannion 2012, Forinash 2012, ABM 2011, Seema 1999).

Do not use as a galactagogue without medical supervision.

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Metoclopramide is also known as


Metoclopramide in other languages or writings:

Group

Metoclopramide belongs to this group or family:

Tradenames

Main tradenames from several countries containing Metoclopramide in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 75 (30 - 100) %
Molecular weight 300 daltons
Protein Binding 30 %
VD 3,5 l/Kg
pKa 14,49 -
Tmax 1 - 2 hours
T1/2 4 - 6 hours
M/P ratio 0,5 - 4 -
Theoretical Dose 0,003 - 0,024 mg/Kg/d
Relative Dose 0,6 - 4,7 %
Relat.Ped.Dose 0,6 - 4,7 %

References

  1. ABM: Brodribb W. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018. Breastfeed Med. 2018 Jun;13(5):307-314 Abstract Full text (link to original source) Full text (in our servers)
  2. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  3. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  4. Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ; Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Abstract Full text (in our servers)
  5. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  6. Anderson PO. The galactogogue bandwagon. J Hum Lact. 2013 Abstract
  7. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  8. Pistilli B, Bellettini G, Giovannetti E, Codacci-Pisanelli G, Azim HA Jr, Benedetti G, Sarno MA, Peccatori FA. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013 May;39(3):207-11. Abstract
  9. Winterfeld U, Meyer Y, Panchaud A, Einarson A. Management of deficient lactation in Switzerland and Canada: a survey of midwives' current practices. Breastfeed Med. 2012 Aug;7:317-8. Abstract
  10. Ingram J, Taylor H, Churchill C, Pike A, Greenwood R. Metoclopramide or domperidone for increasing maternal breast milk output: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2012 Abstract
  11. Forinash AB, Yancey AM, Barnes KN, Myles TD. The use of galactogogues in the breastfeeding mother. Ann Pharmacother. 2012 Oct;46(10):1392-404. Abstract
  12. Mannion C, Mansell D. Breastfeeding self-efficacy and the use of prescription medication: a pilot study. Obstet Gynecol Int. 2012;2012:562704. Abstract Full text (link to original source) Full text (in our servers)
  13. ABM. Academy Of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #9: Use of galactogogues in initiating or augmenting the rate of maternal milk secretion (First Revision January 2011). Breastfeed Med. 2011 Abstract Full text (link to original source) Full text (in our servers)
  14. Fife S, Gill P, Hopkins M, Angello C, Boswell S, Nelson KM. Metoclopramide to augment lactation, does it work? A randomized trial. J Matern Fetal Neonatal Med. 2011 Abstract
  15. Muresan M. Successful relactation--a case history. Breastfeed Med. 2011 Abstract
  16. ABM. Comité de Protocolos de la Academia Médica de Lactancia Materna. ABM Protocolo Clínico #9: Uso de Galactogogos para Iniciar o aumentar la tasa de secreción de Leche Materna. Breastfeed Med. 2011 Full text (link to original source) Full text (in our servers)
  17. Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Abstract Full text (link to original source) Full text (in our servers)
  18. Zuppa AA, Sindico P, Orchi C, Carducci C, Cardiello V, Romagnoli C. Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. J Pharm Pharm Sci. 2010;13(2):162-74. Abstract Full text (link to original source) Full text (in our servers)
  19. Sakha K, Behbahan AG. Training for perfect breastfeeding or metoclopramide: which one can promote lactation in nursing mothers? Breastfeed Med. 2008 Abstract
  20. Marasco L. Inside track. Increasing your milk supply with galactogogues. J Hum Lact. 2008 Abstract
  21. Bryant CA. Nursing the adopted infant. J Am Board Fam Med. 2006 Abstract Full text (link to original source) Full text (in our servers)
  22. Hansen WF, McAndrew S, Harris K, Zimmerman MB. Metoclopramide effect on breastfeeding the preterm infant: a randomized trial. Obstet Gynecol. 2005 Abstract
  23. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  24. Fisher AA, Davis MW. Serotonin syndrome caused by selective serotonin reuptake-inhibitors-metoclopramide interaction. Ann Pharmacother. 2002 Abstract
  25. Gabay MP. Galactogogues: medications that induce lactation. J Hum Lact. 2002 Aug;18(3):274-9. Abstract
  26. Biervliet FP, Maguiness SD, Hay DM, Killick SR, Atkin SL. Induction of lactation in the intended mother of a surrogate pregnancy: case report. Hum Reprod. 2001 Abstract
  27. Cheales-Siebenaler NJ. Induced lactation in an adoptive mother. J Hum Lact. 1999 Abstract
  28. Seema, Patwari AK, Satyanarayana L. Relactation: an effective intervention to promote exclusive breastfeeding. J Trop Pediatr. 1997 Abstract
  29. Emery MM. Galactogogues: drugs to induce lactation. J Hum Lact. 1996 Mar;12(1):55-7. Review. No abstract available. Abstract
  30. Kramer P. Breast feeding of adopted infants. BMJ. 1995 Abstract Full text (link to original source) Full text (in our servers)
  31. Nemba K. Induced lactation: a study of 37 non-puerperal mothers. J Trop Pediatr. 1994 Abstract
  32. Budd SC, Erdman SH, Long DM, Trombley SK, Udall JN Jr. Improved lactation with metoclopramide. A case report. Clin Pediatr (Phila). 1993 Abstract
  33. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993 Jul;48(7):616-25. Review. Abstract Full text (link to original source) Full text (in our servers)
  34. Ertl T, Sulyok E, Ezer E, Sárkány I, Thurzó V, Csaba IF. The influence of metoclopramide on the composition of human breast milk. Acta Paediatr Hung. 1991 Abstract
  35. Quiel V. [Dystonic-dyskinetic syndrome following metoclopramide (Cerucal) administration to promote lactation]. Z Arztl Fortbild (Jena). 1989 Abstract
  36. Ehrenkranz RA, Ackerman BA. Metoclopramide effect on faltering milk production by mothers of premature infants. Pediatrics. 1986 Abstract
  37. Kauppila A, Anunti P, Kivinen S, Koivisto M, Ruokonen A. Metoclopramide and breast feeding: efficacy and anterior pituitary responses of the mother and the child. Eur J Obstet Gynecol Reprod Biol. 1985 Abstract
  38. Gupta AP, Gupta PK. Metoclopramide as a lactogogue. Clin Pediatr (Phila). 1985 Abstract
  39. Kauppila A, Arvela P, Koivisto M, Kivinen S, Ylikorkala O, Pelkonen O. Metoclopramide and breast feeding: transfer into milk and the newborn. Eur J Clin Pharmacol. 1983 Abstract
  40. de Gezelle H, Ooghe W, Thiery M, Dhont M. Metoclopramide and breast milk. Eur J Obstet Gynecol Reprod Biol. 1983 Abstract
  41. Tolino A, Tedeschi A, Farace R, Granata P. The relationship between metoclopramide and milk secretion in puerperium. Clin Exp Obstet Gynecol. 1981 Abstract
  42. 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 Abstract
  43. Kauppila A, Kivinen S, Ylikorkala O. A dose response relation between improved lactation and metoclopramide. Lancet. 1981 Abstract
  44. Lewis PJ, Devenish C, Kahn C. Controlled trial of metoclopramide in the initiation of breast feeding. Br J Clin Pharmacol. 1980 Abstract Full text (link to original source) Full text (in our servers)
  45. Brouwers JR, Assies J, Wiersinga WM, Huizing G, Tytgat GN. Plasma prolactin levels after acute and subchronic oral administration of domperidone and of metoclopramide: a cross-over study in healthy volunteers. Clin Endocrinol (Oxf). 1980 Abstract
  46. Guzmán V, Toscano G, Canales ES, Zárate A. Improvement of defective lactation by using oral metoclopramide. Acta Obstet Gynecol Scand. 1979 Abstract
  47. Sousa PL. Letter: Metoclopramide and breast-feeding. Br Med J. 1975 Abstract Full text (link to original source) Full text (in our servers)
  48. Arroyo H, Aubert L. [Galactorrhoea following metoclopramide treatment]. Presse Med. 1971 Abstract

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