Last update: May 13, 2019

Sulpiride

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

Selective dopamine antagonist that increases prolactin levels and acts as an antipsychotic, antidepressant, antiemetic and intestinal prokinetic (McMurdo 1987, Kato 1975).
It is prescribed as a treatment for depression, psychosis, Tourette syndrome and vertigo. It is also used as a galactagogue (Shaefer 2007 p619, Gabay 2002, Emery 1996).
Its isomer, levosulpiride, is also used in functional gastrointestinal disorders such as dyspepsia, pain and nausea.
Oral or intravenous presentations administered in two to three doses per day.

Its low molecular weight and poor protein binding in plasma may cause a significant amount to be excreted in breast milk (Aono 1979).
Its low oral bioavailability (Bressolle 1992, Wiesel 1980) hinders or prevents its passage to infant plasma from ingested breast milk, except in the case of premature babies and during the immediate neonatal period, in which there may be greater intestinal permeability.
Only mild and infrequent side effects have been observed in mothers receiving this medication (Zuppa 2010) and no side effects have been reported in their lactating infants (Zuppa 2010).

It is adminstered as a GALACTOGOGUE in 50 mg doses, two to three times per day from the immediate postpartum period and for about 1 to 4 weeks (ABM 2011, Shaefer 2007 p619, Zuppa 2010, Gabay 2002).
Significant increases in prolactin and milk volume (Ylikorkala 1984 and 1982, Polatti 1982, Aono 1979) and increased duration of breastfeeding (Aono 1982) have been reported in mothers treated with sulpiride, also weight gain has been observed in their infants (Ylikorkala 1982).
In one study, the galactagogue effect was observed in primiparous but not in multiparous women (Aono 1982). After the neonatal period (first month), although an increase in prolactin can be measured, no increase in milk production or infant weight gain was observed (Barguño 1988).

Its usefulness as a galactagogue has been disputed since only studies with questionable methodologies have shown this benefit (O'Leary 1982). These include old studies with poor breastfeeding techniques, frequent formula supplementation and high rate of abandonment.

Due to the (unpublished) possibility of psychotropic effects on the infant and its possible maternal side effects (parkinsonism, neuroleptic malignant syndrome, arrhythmias) (Shiraiwa 2018, Desai 2018, Martí 2011, Ciszowski 2010), some authors do not consider appropriate to use of this medication as a galactagogue (Lasich 2005, Gabay 2002).
Published side effects occurred in patients taking sulpiride for more than 4 weeks (Shiraiwa 2018) or in high doses.

The best galactagogue is frequent and at demand breastfeeding with correct technique in a self-confident mother (ABM 2018 and 2011, Mannion 2012, Forinash 2012, O'Leary 1982). Do not use as a galactagogue without sanitary control.
Support to the nursing mother and building self-confidence and self-efficacy regarding breastfeeding are aspects to be strengthened before using galactagogue drugs.


See below the information of this related product:

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Sulpiride in other languages or writings:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 25 - 35 %
Molecular weight 341 daltons
Protein Binding 40 %
VD 0,9 - 2,7 l/Kg
Tmax 3 - 6 hours
T1/2 6 - 9 hours
Theoretical Dose 0,15 (0,04 - 0,3) mg/Kg/d
Relative Dose 9 (2,4 - 18) %
Relat.Ped.Dose 3 (0,8 - 6) %

References

  1. ABM: Brodribb W. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018. Breastfeed Med. 2018 Jun;13(5):307-314 Abstract Full text (link to original source) Full text (in our servers)
  2. Wockhardt. Sulpiride. Drug Summary. 2018 Full text (in our servers)
  3. Sanofi. Sulpirida. Ficha técnica. 2018 Full text (in our servers)
  4. Desai D, Gupta K, Kumar R, Biswas A. Levosulpiride-induced neuroleptic malignant syndrome in rheumatoid arthritis. BMJ Case Rep. 2018 Aug 11;2018. pii: bcr-2018-224679. Abstract
  5. Shiraiwa N, Tamaoka A, Ohkoshi N. Clinical features of drug-induced Parkinsonism. Neurol Int. 2018 Dec 20;10(4):7877. Abstract
  6. Mannion C, Mansell D. Breastfeeding self-efficacy and the use of prescription medication: a pilot study. Obstet Gynecol Int. 2012;2012:562704. Abstract Full text (link to original source) Full text (in our servers)
  7. ABM. Academy Of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #9: Use of galactogogues in initiating or augmenting the rate of maternal milk secretion (First Revision January 2011). Breastfeed Med. 2011 Abstract Full text (link to original source) Full text (in our servers)
  8. ABM. Comité de Protocolos de la Academia Médica de Lactancia Materna. ABM Protocolo Clínico #9: Uso de Galactogogos para Iniciar o aumentar la tasa de secreción de Leche Materna. Breastfeed Med. 2011 Full text (link to original source) Full text (in our servers)
  9. Martí Massó JF, Ruiz-Martínez J, Bergareche A, López de Munain A. [Parkinsonism induced by sulpiride and veralipride: two different stories]. Med Clin (Barc). 2011 Oct 15;137(10):473-4. Abstract
  10. Zuppa AA, Sindico P, Orchi C, Carducci C, Cardiello V, Romagnoli C. Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. J Pharm Pharm Sci. 2010;13(2):162-74. Abstract Full text (link to original source) Full text (in our servers)
  11. Ciszowski K, Szpak D, Wilimowska J. [Toxicity of sulpiride]. Przegl Lek. 2010;67(8):606-9. Review. Polish. Abstract
  12. Lasich AJ. Sulpiride and breastfeeding. S Afr Med J. 2005 Sep;95(9):624-6. Abstract Full text (link to original source) Full text (in our servers)
  13. Gabay MP. Galactogogues: medications that induce lactation. J Hum Lact. 2002 Aug;18(3):274-9. Abstract
  14. Emery MM. Galactogogues: drugs to induce lactation. J Hum Lact. 1996 Mar;12(1):55-7. Review. No abstract available. Abstract
  15. Bressolle F, Brès J, Fauré-Jeantis A. Absolute bioavailability, rate of absorption, and dose proportionality of sulpiride in humans. J Pharm Sci. 1992 Jan;81(1):26-32. Abstract
  16. Barguño JM, del Pozo E, Cruz M, Figueras J. Failure of maintained hyperprolactinemia to improve lactational performance in late puerperium. J Clin Endocrinol Metab. 1988 Apr;66(4):876-9. Abstract
  17. McMurdo ME, Howie PW, Lewis M, Marnie M, McEwen J, McNeilly AS. Prolactin response to low dose sulpiride. Br J Clin Pharmacol. 1987 Aug;24(2):133-7. Abstract Full text (link to original source) Full text (in our servers)
  18. Ylikorkala O, Kauppila A, Kivinen S, Viinikka L. Treatment of inadequate lactation with oral sulpiride and buccal oxytocin. Obstet Gynecol. 1984 Jan;63(1):57-60. Abstract
  19. Polatti F. Sulpiride isomers and milk secretion in puerperium. Clin Exp Obstet Gynecol. 1982 Abstract
  20. Ylikorkala O, Kauppila A, Kivinen S, Viinikka L. Sulpiride improves inadequate lactation. Br Med J (Clin Res Ed). 1982 Jul 24;285(6337):249-51. Abstract Full text (link to original source) Full text (in our servers)
  21. Aono T, Aki T, Koike K, Kurachi K. Effect of sulpiride on poor puerperal lactation. Am J Obstet Gynecol. 1982 Aug 15;143(8):927-32. Abstract
  22. O'Leary RM. Sulpiride improves inadequate lactation. Br Med J (Clin Res Ed). 1982 Sep 18;285(6344):807. No abstract available. Abstract Full text (link to original source) Full text (in our servers)
  23. Wiesel FA, Alfredsson G, Ehrnebo M, Sedvall G. The pharmacokinetics of intravenous and oral sulpiride in healthy human subjects. Eur J Clin Pharmacol. 1980 May;17(5):385-91. Abstract
  24. Aono T, Shioji T, Aki T, Hirota K, Nomura A, Kurachi K. Augmentation of puerperal lactation by oral administration of sulpiride. J Clin Endocrinol Metab. 1979 Mar;48(3):478-82. Abstract
  25. Kato Y, Ohgo S, Chihara K, Imura H. Stimulation of human prolactin secretion by sulpiride. Endocrinol Jpn. 1975 Oct;22(5):457-60. Abstract Full text (link to original source) Full text (in our servers)

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