An unusual prescription

A friend of mine, who is also a pharmacist rang me a call yesterday after he received an unusual prescription.

A breastfeeding mother was advised metoclopramide after she complained of lactation insufficiency.

Well, to be honest, I had never heard of it. And I did my research.

Metoclopramide, commonly used as a prokinetic agent either for anti-emesis or gastric emptying also increases serum prolactin.

There have been several studies supporting the evidence of increased milk production along with domperidone which also belongs to the same class as metoclopramide. However, exact efficacy and safety have not been yet established.

Upon comparison, domperidone is excreted in breast milk in a minute amount insignificant to cause any harm to a baby while metoclopramide is found in the plasma serum of breastfed infants but no adverse effects are yet reported. Nevertheless, there should be attentive monitoring as metoclopramide can cross the blood-brain barrier.

From the mother’s safety point of view, domperidone is safer.

Metoclopramide, as stated above, can cross the blood-brain barrier, and being a dopamine antagonist can cause neurobehavioral changes like drowsiness, headache, and even depression which is already at a spike postpartum. Upon toxicity, metoclopramide can cause extrapyramidal symptoms characterized by tremors, involuntary grimaces, and jerking.

If you or anyone of your acquaintance is prescribed with any of these galactagogues, ask them to be alert. On the appearance of any unusual signs, consult the expert as soon as possible.