Sulpiride

Selective dopamine antagonist that increases prolactin levels and acts as an antipsychotic, antidepressant, antiemetic and intestinal prokinetic ^{(McMurdo 1987, Kato 1975}). It is prescribed as a treatment for depression, psychosis, Tourette syndrome and vertigo. It is also used as a galactagogue ^{(Shaefer 2007 p619, Gabay 2002, Emery 1996)}. Oral or intravenous presentations administered in two to three doses per day.

It is excreted in breast milk in amounts that could be significant ^{(Aono 1979)}. Other authors have found negligible excretion in breast milk. ^{(Saito 2022)}

Its low oral bioavailability ^{(Bressolle 1992, Wiesel 1980)} hinders or prevents its passage to infant plasma from ingested breast milk, except in the case of premature babies and during the immediate neonatal period, in which there may be greater intestinal permeability.

Only mild and infrequent side effects have been observed in mothers receiving this medication and no side effects have been reported in their lactating infants. ^{(Zuppa 2010, Ylikorkala 1984 y 1982)}

It is adminstered as a GALACTOGOGUE in 50 mg doses, two to three times per day from the immediate postpartum period and for about 1 to 4 weeks. ^{(ABM 2011, Shaefer 2007 p619, Zuppa 2010, Gabay 2002)}

Significant increases in prolactin and milk volume ^{(Ylikorkala 1984 and 1982, Polatti 1982, Aono 1979)} and increased duration of breastfeeding have been reported in mothers treated with sulpiride, also weight gain has been observed in their infants. ^{(Aono 1982, Ylikorkala 1982)}

In one study, the galactagogue effect was observed in primiparous but not in multiparous women ^{(Aono 1982)}. After the neonatal period (first month), although an increase in prolactin can be measured, no increase in milk production or infant weight gain was observed. ^{(Barguño 1988)}

Its usefulness as a galactagogue has been disputed since only studies with questionable methodologies have shown this benefit ^{(O'Leary 1982)}. These include old studies with poor breastfeeding techniques, frequent formula supplementation and high rate of abandonment.

Due to the (unpublished) possibility of psychotropic effects on the infant and its possible maternal side effects (parkinsonism, neuroleptic malignant syndrome, arrhythmias) ^{(Shiraiwa 2018, Desai 2018, Martí 2011, Ciszowski 2010)}, some authors do not consider appropriate to use of this medication as a galactagogue ^{(Lasich 2005, Gabay 2002)}. Published side effects occurred in patients taking sulpiride for more than 4 weeks ^{(Shiraiwa 2018)} or in high doses.

The best galactagogue is frequent and at demand breastfeeding with correct technique in a self-confident mother ^{(ACOG 2021, ABM 2018 and 2011, Mannion 2012, Forinash 2012, O'Leary 1982)}. Do not use as a galactagogue without sanitary control. Support to the nursing mother and building self-confidence and self-efficacy regarding breastfeeding are aspects to be strengthened before using galactagogue drugs. ^{(ACOG 2021)}

See below the information of these related products:

• Levosulpiride (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Maternal Depression (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Maternal Psychotic Disorder. Maternal psychosis, schizophrenia, bipolar disorder (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)