Sulpiride is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is used as a psychotherapeutic agent and galactogogue in other countries. Sulpiride increases serum prolactin, but its clinical value in increasing milk supply is questionable. In a study that enrolled only mothers with documented low milk production a few weeks postpartum, sulpiride was effective in increasing milk volume, but it was only more effective than placebo in avoiding supplementation in those with no initial milk production. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production.[1,2] If mothers are provided instruction in good breastfeeding technique and breastfeed frequently, sulpiride is unlikely to provide additional benefit. Whether sulpiride has any benefit as a galactogogue in women who continue to have insufficient milk production after nursing technique and frequency have been optimized has not been studied adequately.
Sulpiride is excreted into breastmilk in rather large amounts, far above the accepted value of 10% of the maternal weight-adjusted dosage in some cases, but blood concentrations in breastfed infants have not been evaluated. Two studies found no adverse effects in breastfed infants whose mothers were treated with sulpiride for 2 to 4 weeks as a galactogogue, although others estimated that the dose in milk was high enough to increase serum prolactin in breastfed infants.[3]
Postpartum mothers are at a relatively high risk for postpartum depression and sulpiride can cause depression as a side effect. Therefore, sulpiride should be avoided in women with a history of major depression and not used for prolonged periods in any mothers during this time of high susceptibility. Tiredness occurred occasionally and cases of headache and leg edema have also been reported in nursing mothers taking sulpiride as a galactogogue.[4,5]