January 20, 2020
Galactogogues are substances that increase milk production, and can be in the form of prescription medications, herbs, or foods1. Complete and frequent milk removal is always the primary method for increasing milk supply at any stage of lactation. Galactogogues will not increase the milk supply if complete and frequent milk removal is not occurring.
The most common prescription galactogogues are metoclopramide and domperidone, both of which are manufactured for GI purposes, such as nausea, gastroesophageal reflux, and gastroparesis.
Metoclopramide is known to increase prolactin levels by inhibiting dopamine, and has been shown in some studies to as much as double the milk supply2. It is not approved by the US Food and Drug Administration (FDA) for use as a galactogogue. Because metoclopramide crosses through the blood-brain barrier, central nervous system side effects are common, such as fatigue, dizziness, tremors, anxiety and depression2. The risks of neurologic side effects increase with prolonged use, so if metoclopramide is used, the mother needs close monitoring, and duration should be limited to just a few weeks.
Domperidone also increases prolactin levels by inhibiting dopamine, and is as effective as metoclopramide in increasing the milk supply2,3. It is much less likely to cross the blood brain barrier, so that neurologic side effects are uncommon. Domperidone is known to prolong the QT interval, so women at risk for arrhythmias or prolonged QT due to underlying heart disease or taking other medications should not take this. Domperidone is not manufactured in the United States, thus is not FDA- approved. The FDA considers it illegal to prescribe domperidone in the US. Domperidone is widely used in many other countries.
Many mothers turn to foods and herbs to increase the supply. There is limited information on their safety and effectiveness. Common substances believed to increase milk supply include fenugreek, alfalfa, ginger, caraway, fennel, blessed thistle, torbangun, moringa leaf, goats rue, and shatavari. Resources for further information on foods and herbs as galactogogues include:
- The LactMed database from the National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK501922/
- Academy of Breastfeeding Medicine Protocol entitled ‘Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion’ https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/9-galactogogues-protocol-english.pdf
- Making More Milk by Lisa Marasco MA, IBCLC, and Diana West BA, IBCLC, 2nd edition
- Natural Medicines Database naturaldatabase.com
- Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #9: Use of galactogogues in initiating or augmenting the rate of maternal milk secretion (2nd revision 2018) Breastfeed Med. 13(5):41-46.
- Ingram J, Taylor H, Churchill C, Pike A, Greenwood R. Metoclopramide or domperidone for increasing maternal breast milk output: a randomized controlled trial Arch Dis Child Fetal Neonatol Ed 2012; 97: F241-245
- Osadchy A, Moretti ME, Koren G. Effect of Domperidone on Insufficient Lactation in Puerperal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Obstet Gyn Internat Vol 2012 11 pages