Metoclopramide

Should I use metoclopramide to increase my milk supply?

Metoclopramide is a drug that is used to control nausea and vomiting. Because of its ability to increase the milk hormone prolactin, it has been used to increase milk supply. Its use for this purpose is unapproved. The ability of metoclopramide to increase milk supply is questionable. Mothers who use it may develop a range of side-effects; some rare ones are permanent or life-threatening. The risk to babies is lower.

A) Describing metoclopramide

Metoclopramide is a medication that is sometimes used to increase milk supply.

It was developed in the 1960s. It is approved to:

  • Treat nausea and vomiting in patients with gastroesophageal reflux disease.
  • Control nausea and vomiting in chemotherapy patients.
  • Improve stomach emptying.

It is used without government approval (off-label use) to increase milk supply.

Metoclopramide works by blocking the action of the neurotransmitter, dopamine in the brain and nerves in the body. By blocking dopamine, it indirectly increases prolactin levels, a hormone which helps mothers make milk.

Please work with your health-care providers if you are taking metoclopramide. 

B) Effectiveness of metoclopramide

The few good studies of the ability of metoclopramide to increase milk supply show that its value is questionable (NIH). 

C) Taking metoclopramide

Metoclopramide is taken as a tablet before meals or before sleep. Most studies use doses of 10 mg 2 or 3 times for 7 to 14 days. There are no studies to show that higher or longer doses are safe or result in more milk.

D) Side-effects of metoclopramide

1) Possible effects on the mother

Mothers should stop metoclopramide if they develop any side-effects. Levels in the adult body fall by one-half in 4.5 to 8.5 hours (McGovern 1986), and it takes about 42 hours (1.7 days) for levels in the body to be very low. 

Metoclopramide has a long list of possible side-effects. One online survey of mothers taking metoclopramide found the following (Hale 2018):

  • Depression (12%)
  • Effects on the brain including dizziness, headache, involuntary grimacing, tremors (1 to 7%)
  • Palpitations or racing heart rate (4.8%)

Other reported side-effects include (NIH):

  • Tiredness
  • Nausea
  • Headache
  • Dry mouth
  • Restless legs
  • Anxiety
  • Abnormal heart rhythms 

Metoclopramide may cause the same types of heart rhythm abnormalities as domperidone, however, the risk is lower (Arana 2015; Claassen 2005; Ellidokuz 2003; Siddique 2009).

a) Involuntary movement disorders.

Metoclopramide can increase the risk of numerous movement disorders.

Long-term use of metoclopramide increases the risk of tardive dyskinesia. This is a disorder that results in involuntary, repetitive body movements. It mostly affects the face but can also involve the body. Movements may include the following (Cornett 2017):

  • Grimacing
  • Sticking out the tongue
  • Smacking or pursing the lips
  • Frowning
  • Chewing or chomping
  • Excessive blinking
  • Gasping, abnormal breathing 

The rates of tardive dyskinesia caused by metoclopramide use has been estimated to be in the range of 0.1% per 1000 patient years (Al-Saffar 2019). Tardive dyskinesia can be temporary or permanent.

b) Life-threatening reactions

Neuroleptic malignant syndrome can be caused by metoclopramide. It is a rare but life-threatening reaction involving destruction of the muscles, high blood salt (potassium) levels, seizures, kidney failure, and death. Signs include the following:

  • Confusion
  • Tight muscles
  • Sweating
  • Fast heart rate

c) Interactions with other drugs

Metoclopramide may interact with a large number of other drugs to increase the risk of side-effects. This includes:

  • Antidepressants including monoamine oxidase inhibitors and SSRIs
  • Antipsychotics
  • Antihistamines
  • Sedatives in the “pam” family (e.g. lorazepam, diazepam)

2) Possible effects on the baby

When their mothers use metoclopramide, babies take in less than 10% of the mother’s dose. A few small studies have shown babies have higher than normal levels of prolactin and possible tummy problems (Kauppila 1983).  

References

Al-Saffar A, Lennernäs H, Hellström PM. Gastroparesis, metoclopramide, and tardive dyskinesia: Risk revisited. Neurogastroenterol Motil. 2019 Nov;31(11):e13617

Arana A, Johannes CB, McQuay LJ, et al. Risk of Out-of-Hospital Sudden Cardiac Death in Users of Domperidone, Proton Pump Inhibitors, or Metoclopramide: A Population-Based Nested Case-Control Study. Drug Safety. 2015;38(12):1187-1199

Claassen S, Zünkler BJ. Comparison of the effects of metoclopramide and domperidone on HERG channels. Pharmacology. 2005 Apr;74(1):31-6 

Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-Induced Tardive Dyskinesia: A Review and Update. Ochsner J. 2017 Summer;17(2):162-174

Ellidokuz E, Kaya D. The effect of metoclopramide on QT dynamicity: double-blind, placebo-controlled, cross-over study in healthy male volunteers. Aliment Pharmacol Ther. 2003 Jul 1;18(1):151-5

Hale TW, Kendall-Tackett K, Cong Z. Domperidone versus metoclopramide: Self-reported side effects in a large sample of breastfeeding mothers who used these medications to increase milk production. Clin Lact. 2018;9:10-7
 
Kauppila A, Arvela P, Koivisto M, et al. Metoclopramide and breast feeding: transfer into milk and the newborn. Eur J Clin Pharmacol. 1983; 25(6):819–823
 
McGovern EM, Grevel J, Bryson SM. Pharmacokinetics of high-dose metoclopramide in cancer patients. Clin Pharmacokinet. 1986 Nov-Dec;11(6):415-24

Siddique SM, Shariff N, Vesuwala N, et al.  Metoclopramide as a possible cause of prolonged QT syndrome and torsade de pointes in a patient with heart failure and renal insufficiency. Ann Intern Med. 2009 Apr 7;150(7):502-4

United States National Institute of Health (NIH), National Library of Medicine, Toxnet, Drugs and Lactation Database (Lactmed) [Internet]. Bethesda: U.S. National Library of Medicine; [date unknown] [cited 2020 Apr 15]