Metoclopramide Hydrochloride

Metoclopramide, a substituted benzamide, is 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)} 

There is little evidence of its efficacy as a galactogogue in mothers of full-term non-premature infants, and beyond the neonatal period ^{(Foong 2020, McGuire 2018)}. The galactagogue effect has not been well demonstrated in meta-analysis and other better designed studies ^{(Shen 2021, Grzeskowiak 2019, Sachs 2013, Fife 2011, Sakha 2008, Hansen 2005, Lewis 1980)}.

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.

It can cause extrapyramidal effects and depression ^{(Hale 2018, 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 ^{(Hale 2018)}.

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.^{(ABM-Brodribb 2018, Anderson 2013, Mannion 2012, Forinash 2012, ABM 2011, Seema 1997)}

Do not use as a galactagogue without medical supervision.