Contact Melissa for breastfeeding support with a lactation consultant
online or in Spokane, Coeur d’Alene, and North Idaho.
What Are Galactagogues?
Galactagogues are items that can be taken internally to help a mother increase her breast milk production (milk supply) and are available in the form of prescribed medications, herbs or dietary supplements, or food or drink. Most mothers are able to increase their milk supply with increased stimulation of the breast (either by baby, breastpump, or self-expression) and galactagogues to increase breast milk supply should be reserved for situations in which stimulation alone is not enough to support a mother’s milk supply.
How Do Medications Increase Milk Supply?
Medications work to increase milk supply by raising prolactin levels and suppressing dopamine in the body. (Prolactin is a hormone that stimulates the synthesis and secretion of milk; dopamine inhibits the body’s release of prolactin.) There are two main medications that are used for this purpose: domperidone (trade names Motilium or Motilidone) and metoclopramide (trade name Reglan).
Of particular concern when exploring pharmacological galactagogues to increase milk supply is how the medication may cross the blood-brain barrier of the mother’s body. The blood-brain barrier is the separation of circulating blood and brain fluid in the central nervous system. The molecular weight of the drug is what determines whether or not it will cross this barrier. When drug molecules cross this barrier, certain maternal side effects (to be discussed with each medication, domperidone and metoclopramide, listing below) can occur.
As with any medications, drug interactions should be discussed with her pharmacist or healthcare provider.
Domperidone
What is domperidone: Domperidone is generally used for nausea and vomiting, dyspepsia, and reflux, and is also used for increasing breast milk supply.
How domperidone works: Domperidone blocks dopamine from inhibiting prolactin production. Domperidone has minimal drug transfer across the blood-brain barrier, due to its molecular weight, and is not known to cause depression; therefore, domperidone is considered to be the ideal galactagogue (as compared to metoclopramide or Reglan).
Domperidone dosage: 10 to 20 mg three to four times a day for 3 to 8 weeks (although longer term usage may be appropriate)
Possible maternal side effects: Dry mouth, headache, itching, skin rash, abdominal cramps
Possible infant side effects: None reported for breastfed infants
Domperidone contraindications: If you have a history of cardiac problems, discuss the use of domperidone with your doctor.
Notes: Due to FDA regulations,domperidone is not available in regular pharmacies in the United States, but is available from certain US-based compounding pharmacies (Spokane area moms should see the section below, “Local Resources”) and online from Canada. The FDA issued a policy statement about the use of domperidone in breastfeeding mothers, as the drug passes through to the breast milk; however, many respected medical doctors whose practices focus mainly on lactation indicate that while most drugs pass through to the milk supply, most are safe for both mother and baby, including domperidone. Additionally, the American Academy of Pediatrics (AAP) indicates that domperidone is usually compatible with breastfeeding.
Metoclopramide
What is metoclopramide: Metoclopramide is generally used in adults and infants for various forms of nausea and reflux, and is also used for increasing breast milk supply.
How metoclopramide works: Metoclopramide blocks dopamine from inhibiting prolactin production. It’s molecular weight allows the drug to cross the blood-brain barrier, which results in an increased risk of depression.
Metoclopramide dosage: 10 mg three three times per day until milk volume increases, then tapering off over 4-6 days (long-term use is not advised)
Possible maternal side effects: Diarrhea, sedation, nausea, depression
Possible infant side effects: None reported for breastfed infants
Metoclopramide contraindications: If you have a history of hypertension, discuss the use of metoclopramide with your doctor. Metoclopramide is also associated with an increased risk of severe depression, a particular concern for all mothers; as such, long-term use is not suggested. Speak with your healthcare provider regarding the duration of use of metoclopramide.
Mothers often need support outside of their healthcare provider’s presence for maintaining a healthy milk supply and may benefit from the experiences of other mothers. For this purpose, Melissa offers support groups throughout Spokane and North Idaho, free of charge. In addition, she is currently available for consultations in the home setting.
In addition to purchasing domperidone (Motilium) or metoclopramide (Reglan) online, mothers in the Eastern Washington/North Idaho area have the added benefit of a local compounding pharmacy from which they may fill a domperidone prescription for increasing their milk supply:
Fifth and Browne Pharmacy
(509) 838-4117
(509) 838-0268 FAX
104 West 5th Ave.
Spokane, WA 99204
Melissa can work with your healthcare provider to
support your milk supply and healthy lactation.
Contact her here or by calling (509) 228-8710.
Additional Resources
- Curtis, Cindy. Breastfeeding Online. 2003-2008. <http://www.breastfeedingonline.com/domperidonewhere.shtml>.
- West, Diana, Lisa Marasco, and Carol Maranta. Low Milk Supply. 2009. <http://www.lowmilksupply.org/domperidone-safe.shtml>.
References
- Riordan, Jan. Breastfeeding and Human Lactation. 3rd ed. Sudbury, MA: Jones and Bartlett, 2005.
- Lauwers, Judith, and Anna Swisher. Counseling the Nursing Mother. 4th ed. Sudbury, MA: Jones and Bartlett, 2005.
- Lawrence, Ruth A., and Robert M. Lawrence. Breastfeeding: A Guide for the Medical Profession. 6th ed. Philadelphia, PA: Elsevier Mosby, 2005.
- Hale, Thomas W. Medications and Mothers’ Milk. 13th ed. Amarillo, TX: Hale Publishing.
