• Domperidone has replaced Metoclopramide as the galactogogue of choice in NICU.

Rationale

Metoclopramide (Maxolon) is an anti-dopaminergic agent which has been shown to significantly increase milk yields in mothers with lactational deficiency.

A placebo controlled double blind study of metoclopramide started on the first day post partum and continued for eight days, showed a 50% greater milk yield in the metoclopramide treated group ¹.

In a placebo controlled study of mothers 4-20 weeks post partum metoclopramide 10mg tds for three weeks caused a significant increase in milk yield and in serum prolactin levels. There was no change in the serum concentration of TSH or free thyroxine of either mothers or infants and there was no rise in the prolactin levels in the infants in either group. This study showed no effect on the hypothalamo-hypophyseal axis of the neonate ² .

Metoclopramide taken orally by the mother is transferred to the breast milk. However it was detected in the plasma from only one of the five neonates studied ³ . Exposure of the infant to metoclopramide was 6-24mcg/kg/day compared to the therapeutic dose of 500mcg/kg/day, i.e, less than 5%. Metoclopramide has been used successfully to treat preterm infants with persistent functional feeding intolerance in a dose of 300mcg/kg/day and no side effects were noted ⁴ .

Maternal side effects are mild, uncommon and non-specific, e.g. tiredness. Extra pyramidal dystonia has been reported and parents need to be aware of the possibility.

Recommendations

• Maxolon (metoclopramide) should only be given after the mother has been expressing at least six times in 24 hours for three days. She must have had teaching in effective expressing techniques and positioning of the baby at the breast if possible.
• If the mother is still under obstetric or medical care, she should discuss the possible use of metoclopramide with her medical adviser(s). The RMO may then give the mother a prescription for Maxolon 10mg tds orally for two weeks. This prescription may be repeated as necessary.
• Discuss with the Paediatric Consultant or Lactation Consultant and/or primary charge nurse before starting therapy, to ensure that adequate assistance is in place.

References