魏添勇 醫師 於 2007-04-16 12:12:44 回覆

一天使用低於45mg，不用擔心此藥會造成影響，有人報導會影響神經系統，但不被證實。所以不用怕，禁食一天，等你不嘔吐，就不要吃藥。就可以餵奶。
不相信看下列英文(取自Drugs in pregnancy & lactation, 4th)懶惰可看最下面的結論

Metoclopramide is excreted into human breast milk. Because of ion trapping of the drug in the more acidic (as compared with plasma) milk, accumulation occurs with milk:plasma ratios of 1.8–1.9 after steady-state conditions are reached .

Several studies have examined the effect of metoclopramide as a lactation stimulant in women with inadequate or decreased milk production . One study involved 23 women who had delivered prematurely (mean gestational length, 30.4 weeks) . The drug, by stimulating the release of prolactin from the anterior pituitary, was effective in increasing milk production with doses of 20–45 mg/day . Doses of 15 mg/day were not effective . In one study, metoclopramide caused a shift in the amino acid composition of milk, suggesting an enhanced rate of transition from colostrum to mature milk . No effect on the serum levels of prolactin, thyroid-stimulating hormone, or free thyroxin was observed in nursing infants in a 1985 study of 11 women with lactational insufficiency . A 1994 investigation found a positive response in 78% (25 of 32) of treated women, but the increase in daily milk production was inversely correlated with maternal age .

The total daily dose that would be consumed by a nursing infant during the maternal use of 30 mg/day has been estimated to be 1–45 µg/kg/day . This is much less than the maximum daily dose of 500 µg/kg recommended in infants or the 100 µg/kg/day dosage that has been given to premature infants . Metoclopramide was detected in the plasma of one of five infants whose mothers were taking 10 mg 3 times daily . Adverse effects have been observed in only two infants—both with mild intestinal discomfort . In one case the mother was consuming 30 mg/day and in the other, 45 mg/day .

結論
In summary, metoclopramide apparently does not present a risk to the nursing infant with maternal doses of 45 mg/day or less. One review has stated that the drug should not be used during breast feeding because of the potential risks to the neonate , but there are no published studies to substantiate this caution. Although no adverse effects in the nursing infant have been reported, the American Academy of Pediatrics considers the use of metoclopramide during lactation to be of concern because of the potent central nervous system effects that the drug is capable of producing.