This article is based on Topics in Breastfeeding, Set XII November 2000, Lactation Resource Centre

INTRODUCTION

One of the most common reasons women give for weaning their baby from the breast is an inadequate milk supply. While this can be a perceived rather than a real problem, some women find it difficult to initiate and maintain a milk supply sufficient to totally nourish their baby. Ensuring correct positioning and attachment, increasing the number of breastfeeds and other breastfeeding management suggestions are usually sufficient to increase a woman's milk supply. However, there is still a group of women who struggle to produce enough milk. Galactagogues are substances that are claimed to increase milk supply. It is often difficult to know what can be offered in the way of galactagogues to women. This paper discusses the evidence for the use of medications (both prescription and alternative) to increase milk supply.

PRESCRIPTION MEDICATIONS

Medications may produce spontaneous milk production as a side effect. These include the oral contraceptive pill, major tranquillisers, antidepressants and some antihypertensive medications. Most are not suitable to use during lactation. Some may actually inhibit milk production (eg. the oral contraceptive pill). However there are some medications which have been shown to increase prolactin and milk supply in lactating women and induce a milk supply in non-lactating women, with acceptable side effects.

METOCLOPRAMIDE (MAXOLON, PRAMIN, REGLAN, MAXERAN)

This is probably the most commonly known and used drug to increase milk supply in Australia. It is mainly used for nausea and vomiting. However, it does produce side effects including restlessness, drowsiness, fatigue and lassitude.

A study of metoclopramide found that prolactin levels increased significantly. The amount of breastmilk also increased by between 30 and 40%. Eighty nine percent of the women regarded the response as good during the time they were taking metoclopramide.

Metoclopramide was also shown to increase milk supply in post-partum women who have not been able to establish a milk supply. Two studies showed an increase in breastmilk while taking metoclopramide.

Women with premature infants who have to express to maintain their milk supply until their baby is able to feed at the breast often find the amount of milk they are able to express gradually decreases. A study found milk production increased by 52% within two days of starting metoclopramide. During the study milk supply increased by a mean of 110%. However, once treatment ceased, milk supply began to fall again.

EFFECTS ON THE INFANT

Metoclopramide is present in breastmilk, however, only one in five infants studied had detectable amounts in plasma.

SUMMARY

Metoclopramide is an effective drug for increasing prolactin and milk supply in women. The response is dose dependent although some women simply do not respond. It needs to be taken at least three times a day. Side effects such as gastric cramping and diarrhoea may affect compliance. Long-term use for more than two weeks is generally not recommended.

DOMPERIDONE (MOTILIUM)

Domperidone has properties similar to metoclopramide and is used for gastrointestinal conditions such as nausea and vomiting, and gastro-oesophageal reflux. It is also increases prolactin levels. It causes fewer side effects than metoclopramide.

One study found daily milk production increased and at one month all women in the treatment group were breastfeeding adequately, while only two of the placebo group had sufficient milk. There were similar findings in a group of women treated for low milk supply two weeks postpartum.

SUMMARY

Domperidone given for four to ten days has been shown to increase prolactin levels and milk supply. There appear to be fewer side effects in the mother with this drug compared to metoclopramide. While it appears in breastmilk, there is no indication that it affects the infant in the doses used.

SULPIRIDE

Although the drug sulpiride is not available in Australia, it is used commonly in Africa and South America as a galactagogue.

In two trials, milk production increased and infant weight gain was significantly higher in the treatment group compared with the women taking a placebo.

Sulpiride is also found in breastmilk although there is no report of effects on the infant.

MEDICINAL HERBS

There were reports of plants being used to increase milk supply over 2 500 years ago.

However, caution needs to be exercised when using herbal treatments and purchasing products from reputable companies is recommended.

Just like any medication, adverse effects can occur with herbs.

Mostly there are anecdotal accounts of the effect of fenugreek on milk supply. A recent study investigated the effect on milk production of fenugreek and found there was a significant increase in milk supply. It is uncertain why fenugreek has an effect on milk production.

Garlic has been found to increase the sucking time of the baby at the breast, which may help increase milk supply.

SUMMARY

While a large number of herbs have been reputed to increase milk supply, there is very little written in the medical literature to support or refute the anecdotal information. Women taking herbal remedies must be aware that they are medications and may cause side effects. They need to be purchased from a reputable source and used according to directions. Cost of herbal treatment must also been taken into account.

CONCLUSION

Perceived or real insufficient milk supply is a common concern of women, and is a major cause of infant weaning. While changes to breastfeeding management will be sufficient to increase milk supply in most women, some find benefit in taking galactagogues. Studies on metoclopramide and domperidone, drugs available on prescription in Australia, have been shown to increase prolactin levels and milk supply. These benefits have to be weighed against the side effects of any medication.

A large number of herbs have been used for many years to help women with low milk supplies. At present there is mainly anecdotal evidence that they are effective. Further work needs to be done so that there is consensus about their usage.

It is essential that galactagogues are not used to replace adequate investigation and treatment of low milk supply. It is also important to recognise that some women do not respond to galactagogues. If an adequate trial of a prescription or herbal galactagogue does not produce a response, it should be discontinued.

A more detailed account of the studies is available in the full article.

© Australian Breastfeeding Association, 2000