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The Academy of Breastfeeding Medicine Protocol Committee

BACKGROUND

Galactogogues (or lactogogues) are medications or other substances believed to assist initiation, maintenance, or augmentation of the rate of maternal milk synthesis. Because perceived or actual low milk supply is one of the most common reasons given for discontinuing breastfeeding, both mothers and health professionals have sought medication(s) to address this concern. Evaluation of evidence-based studies and emerging information regarding more serious potential side effects of some galactogogues have resulted in a recent shift in the Academy of Breastfeeding Medicine’s recommendations regarding these drugs and herbs. In 2004, the previous version of this protocol used existing evidence that prescription galactogogues were effective and described when and how to use them. Emerging data suggest that we should exercise more caution in recommending these drugs to induce or increase the rate of milk secretion in lactating women, particularly in women without specific risk factors for insufficient milk supply.

Campbell-Yeo ML, Allen AC, Joseph KS, Ledwidge JM, Caddell K, Allen VM, Dooley KC.
PEDIATRICS Vol. 125 No. 1 January 2010, pp. e107-e114 (doi:10.1542/peds.2008-3441)

Abstract

Objective Domperidone is increasingly prescribed to improve breast milk volume despite a lack of evidence regarding its effects on breast milk composition. We examined the effect of domperidone on the nutrient composition of breast milk.

Elise W-X. Wan, Kaye Davey, Madhu Page-Sharp, Peter E. Hartmann, Karen Simmer & Kenneth F. Ilett
Br J Clin Pharmacol. 2008 August; 66(2): 283–289.

Abstract

What is already known about this subject

• Domperidone is an effective treatment for some mothers with insufficient milk supply.
• However, dose–effect data are not available, and the safety of domperidone use in both mother and infant has been questioned.

What this study adds

• Domperidone only increases milk production in about two-thirds of preterm mothers with insufficient milk supply.
• On average, the responders showed increasing levels of milk production with dose escalation from 30 mg to 60 mg daily.
• The amount of domperidone that transferred into breast milk was very low, and the risk to the breastfed infant is minimal.

Aims To investigate the possibility of a dose–response relationship for the use of domperidone in treating insufficient milk supply in mothers of preterm infants, and to quantify the exposure of the breastfed infant to domperidone.

da Silva OP, Knoppert DC, Angelini MM, Forret PA.
CMAJ. 2001 Jan 9;164(1):17-21.

Abstract

Background: Varying degrees of success have been reported with strategies to increase milk production when lactation is failing. The objective of this study was to investigate the efficacy of domperidone in augmenting milk production in mothers of premature newborns.