Breast-feeding-friendly remedies for refractory GERD / esophageal spasms

[pedinva]

I am a pediatrician and have a breast-feeding mom who is being treated by GI for refractory GERD. The next option suggested by GI is Reglan 10mg PO TID. My sense is that this would be compatible with breast-feeding. Can you confirm?

Also, the GI has suggested the possibility of baclofen for treatment of incompetent LES and amitryptiline for esophageal spasms? Can you comment on the safety of these in lactation?

[admin]

Pedinva:

Reglan is Ok to use in breastfeeding mothers. It even stimulates prolactin levels and moms often make more milk. The problem with it is that after 3 weeks it has a high risk of severe depression; after 3 months it dramatically increases the risk of extrapyramidal symptoms and tardive dyskinesia. So long term use is not advised.

My advise would be to try it for several weeks, if it works, write your patient a prescription for Domperidone (Motillium- Janssen). It is a gastrokinetic agent like Reglan, but it does not enter the brain, hence no such problems.

It does at high doses increase the QT interval and I'd suggest you do an ECG prior to prescribing it. While it is not available in the USA, thousands of moms get it frequently from Canada, from New Zealand, Mexico, or from local compounding pharmacies here in the US.

As for Baclofen, I'd avoid it as it is known to reduce prolactin levels which would destroy the moms milk supply.
As for amitriptyline, you can safely use it in breastfeeding mothers, but the mom will hate it. It causes severe sedation, severe anticholinergic side effects such as constipation, dry mouth, blurred vision. Not really popular with patients.

My advice would be to try the Reglan. If Reglan works, move toward Domperidone.

Tom Hale Ph.D.
InfantRisk Center