Key takeaways

Metoclopramide, the only FDA-approved drug for lactation support in the U.S., has side effects for both the mother and baby, including GI issues, headache, fatigue, and a risk of anxiety and depression in mothers.
The effectiveness of metoclopramide for increasing milk supply can vary significantly, with some patients experiencing a 50 to 100 percent increase, but its use for this purpose is not well-studied.
Lactation consultant Leigh Anne O’Connor discourages the use of metoclopramide due to its potential to exacerbate postpartum depression and anxiety, advocating instead for support and a full lactation evaluation to address breastfeeding issues.
Dr. Christine Masterson suggests non-medical strategies for new moms struggling with breastfeeding, such as staying well-fed and hydrated, managing stress, and seeking support from breastfeeding-savvy individuals, but still presents metoclopramide as an option under certain conditions.

This is part of a series on breastfeeding in support of National Breastfeeding Month (August). Find the full coverage here.

Breastfeeding is often called the “natural” way to feed a baby, but just because something is “natural” doesn’t mean it’s easy. In fact, breastfeeding can be downright difficult: latch issues, cracked nipples, engorgement, and low milk supply all commonly plague the early weeks and months of breastfeeding.

Out of all these problems, low milk supply is probably the most troubling—so it’s understandable why many new moms turn to a number of different strategies to make more milk, including asking their doctor for prescription medications rumored to increase milk supply.

In the United States, there’s only one drug FDA-approved for the use of lactation support: metoclopramide, brand name Reglan. (Canadians are often prescribed domperidone instead, but it’s not approved for sale in the U.S. due to concerns over side effects.) According to Christine Masterson, MD, chief of the women and children’s service line at Summit Medical Group in New Jersey, metoclopramide is a drug commonly used for treating various gastrointestinal issues; it just so happens that one of the drug’s side effects is increased milk production.

“Metoclopramide turns off a chemical in the brain called dopamine, which allows for prolactin elevation,” Dr. Masterson says. (Prolactin is a hormone that promotes milk production.) “It can vary tremendously in how effective it is for breastfeeding, though some patients may receive a 50 to 100 percent increase in milk supply.”

So what’s the problem with using Reglan for breastfeeding? Actually, Dr. Masterson says there are several. For one, the use of metoclopramide for milk production isn’t well-studied. Secondly, there is no clear indication about the dosage for milk production versus GI symptoms. And finally, because metoclopramide passes through breast milk, there can be side effects for both mom and baby.

“The concentration of the drug in the baby’s blood can vary tremendously, but could be as high as 10 percent of the mother’s dosage,” Dr. Masterson reveals. “This may affect the baby’s GI tract: causing more gas formation and abdominal discomfort or changing their bowel movements to diarrhea.”

As unpleasant as that is for baby, the side effects for mom are potentially much worse. Dr. Masterson says that in addition to similar GI issues, headache, fatigue, dry mouth, and certain movement disorders, women may also find that metoclopramide triggers or worsens symptoms of anxiety and depression. At a time when moms are particularly vulnerable to the mood changes brought on by postpartum hormones and the stresses of feeding a newborn around the clock, a drug that carries a serious risk of depression may not be the best choice.

“How we give birth has an impact on how we feel after we give birth,” says New York-based lactation consultant Leigh Anne O’Connor, IBCLC. “If you had a challenging birth, with a planned or unplanned c-section [or another unexpected intervention], breastfeeding will also be challenging.”

These factors combined can create a recipe for postpartum depression, whether a new mother has a history of depression or not (although the chances are higher if she does); O’Connor says she has seen too many women experience symptoms of anxiety and depression while taking metoclopramide to feel comfortable recommending it to her patients.

Instead, she emphasizes the importance of getting support during the early days of breastfeeding. A good place to start is with a full lactation evaluation from an International Board Certified Lactation Consultant (IBCLC), which can reveal whether or not a mother truly has low supply (often there’s some other easily corrected problem masquerading as a supply issue). Even if a mom’s supply is actually low, working with an IBCLC can identify the root cause—and set her on a course toward correcting the problem and building a solid breastfeeding foundation for the future.

“Many people want to breastfeed, but they don’t understand that our healthcare system is not set up to support or educate people on what it actually looks like and what the barriers are,” O’Connor says. “People feel like a failure when it doesn’t go smoothly right away.”

That said, there are some circumstances when a drug like metoclopramide to increase milk supply might be appropriate. According to Dr. Masterson and O’Connor, people who might benefit from using Reglan for breastfeeding include:

women with naturally low levels of prolactin;
women who have had any kind of breast surgery, including reduction;
women with active herpes or HIV;
women with breast hypoplasia;
and adoptive mothers wanting to breastfeed their adopted child.

Generally speaking, it’s better to address the reasons why breastfeeding isn’t working instead of relying on a prescription to solve the problem. Dr. Masterson says new moms should stay well-fed and hydrated, get enough sleep, manage their stress, and surround themselves with supportive, breastfeeding-savvy people.

But unlike O’Connor, she does still present metoclopramide as an option to her patients struggling to breastfeed—as long as they don’t have a history of GI issues or depression.

“If someone comes to me complaining about breastfeeding, I do mention [Reglan] because establishing breastfeeding is really important in the first two to three weeks after birth,” Dr. Masterson explains. “If you use it for [up to] 12 weeks—no longer—then hopefully your breastfeeding will be better established and you won’t need the extra boost.”

If you’re struggling with breastfeeding, you can find an IBCLC in your area here. If you or a loved one is experiencing symptoms of postpartum depression, seek help from a mental health provider immediately.