Breastfeeding & Drugs: Galactogogues

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Breastfeeding and Drugs Topics
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Pre module evaluation
Prescription and Over the Counter Medications
Case Study 28
Case Study 29
Pain Medications
Illicit Drugs
Post module evaluation

A galactogogue is a substance than increases breast milk production. When women are having difficulties with low breast milk production, a full evaluation of breastfeeding techniques and milk transfer must be completed before use of a galactogogue can be considered. The Academy of Breastfeeding Medicine has a protocol Use of Galactogogues in Initiating or Augmenting Maternal Milk Supply (pdf).

In many countries of the world, herbs or various foods are used as galactogogues. These include fenugreek, goat's rue, milk thistle, beer, (see Breastfeeding and Alcohol) papaya, and others. There is little scientific evidence of the efficacy of most of these foods on increasing breast milk production. Fenugreek, which is used as a spice and medicine in India and the Middle East has been the most widely used to increase breast milk supply. Anecdotal reports suggest some efficacy for fenugreek, however this data is very limited. Side effects can include low blood sugar in the mother, maple like odor to sweat, milk and urine, diarrhea and increased asthmatic symptoms. It can be taken as capsules or as tea made from steeping fenugreek seeds ( Memorize ABM Galactogogues, 2004 , Memorize Lawrence, 2011 p389-390).

Several medications have been used as galactogogues. These include metoclopamide, domperidone, and the antipsychotics sulpiride and chlorpromazine. All four of these work by blocking dopamine receptors and subsequently increasing prolactin levels. All these drugs can have side effects including restlessness, mental depression, confusion, anxiety, or agitation. Metaclopramide and Domperidone have been studied the most thoroughly. Metaclopramide in a dose of 10 or 15 mg three times a day has been shown to increase baseline prolactin levels and milk production in mothers of term and premature infants. The mothers of the premature infants were expressing breast milk for their infants ( Memorize Ehrenkranz, 1986 , Memorize Kauppila, 1981 ). Domperidone is not available in the United States. However, studies performed in Canada and Italy show that when Domperidone was given to lactating mothers at a dose of 10 mg three times a day, prolactin levels and milk production increased. There were no reported side effects. ( Memorize Petraglia, 1985 , Memorize da Silva, 2001 ) The FDA recently issued a warning against the use of Domperidone noting that this drug is not approved for any use in the United States. In the past, an intravenous form of Domperidone, which is no longer available, caused serious side effects including cardiac arrthymias, cardiac arrest, and sudden death. In some countries where Domperidone is available, it is labeled with a warning against use by breastfeeding mothers because it can be found in breast milk and the risk of Domperidone to infants is unknown ( Memorize FDA, 2004 ).

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