By Leslie Southard, Pharm.D., CLC

Galactogogues are synthetic or natural substances thought to start, maintain, or increase milk supply. Galactogogues are a controversial subject, because the scientific evidence supporting their use is sparse. Most galactogogues have not been adequately studied to support their use for increasing milk supply. However, galactogogues continue to be used with varying results.

This post will review some of more popular pharmaceutical and herbal galactogogues as well as the evidence available regarding their use.

Pharmaceutical Galactogogues

Domperidone

• One of the more common pharmaceutical galactogogues available, and one of the most studied.
• Originally developed to help control nausea, vomiting, and acid reflux.
• Does not enter the brain which reduces potential side effects.
• Has been proven to moderately increase prolactin levels in both lactating and non-lactating individuals and thus milk supply.
• One study has also shown that increased supply is maintained even if domperidone is slowly tapered off over a two to four week period.
• The relative transfer rate to breastmilk is low, and the relative infant dose is less than 1%.
• Generally well-tolerated, but it does carry a risk of a rare but serious side effect called QTc prolongation. QTc prolongation is a change in heart rhythm that produces fast and irregular heart rates that are potentially dangerous. QTc prolongation has been reported in both the person taking the medication as well as the breastfed infant, but not all QTc prolongation has been symptomatic and other factors may have contributed to the prolongation. Due to this side effect, domperidone is not approved for use in all countries, and some countries have issued warnings against its use.
• The recommended domperidone dose is 10mg to 20mg three times daily. [1,2]

Metoclopramide

• Metoclopramide is another pharmaceutical galactogogue, but its use has fallen out of favor in recent years. It is similar to domperidone in terms of controlling nausea and vomiting and increasing prolactin levels.
• Produces variable increases in milk supply and some individuals do not respond at all.
• Has more significant side effects than domperidone. Potential side effects include headache, depression, abdominal cramps, and potentially permanent extrapyramidal symptoms. Extrapyramidal symptoms are drug-induced uncontrolled arm and leg movements.
• The relative transfer rate to breastmilk is variable and ranges from 5% to 14%.
• Should only be used if other options have been exhausted.
• The recommended dose is 10mg to 15mg three times daily.
• It should not be used for longer than three months, and the dose should be tapered prior to discontinuation. [1,2]

Herbal Galactogogues

There are many herbs used to increase milk supply, and it often varies by culture. Many are used in combination with one another. Some of the more common herbal galactogogues include fenugreek, goat’s rue, milk thistle, oats, shatavari, malunggay, and fennel. Only a few have research behind their use as galactogogues.

Fenugreek

• One of the most common herbs suggested to increase milk supply.
• Thought to increase milk supply through its ability to increase secretions and sweating. The available research on whether this is true is conflicting. One study demonstrated an increase in milk supply while another study demonstrated no increase in milk supply.
• Has several potential side effects, including a decrease in blood sugar, blood pressure, and cholesterol, all of which could be problematic for those who have normal or low levels.
• Can change the odor of urine and sweat to a maple sugar scent, and some reports indicate that fenugreek causes upset stomach in infants.
• Should only be used if other herbs have not increased milk supply.
• The recommended dose is 6g per day in two to three divided doses. [1-3]

Malunggay (Moringa)

• Malunggay, or moringa leaf, is another common herb used to increase milk supply. Malunggay’s mechanism for doing so is unknown, but it has been used for centuries for this purpose.
• One study has demonstrated its ability to increase milk supply in the immediate postpartum, but little is known about its potential side effects and its transfer to breastmilk.
• Malunggay’s safety during pregnancy is also questionable, since one chemical component may increase the risk of miscarriages.
• The recommended dose is is 250mg twice daily. [2,4]

Shatavari

• Shatavari is a lesser known herb used to increase milk supply. Similar to malunggay, shatavari’s mechanism for doing so is unknown but has been used for a long period of time.
• One study has demonstrated its ability to increase milk supply, but shatavari was used in combination with other herbs so it is uncertain how well shatavari works.
• Potential side effects and its transfer to breastmilk are also unknown. [2,5]

Using Galactogogues Wisely

Any use of a galactogogue should be done so under the supervision of a lactation professional and paired with frequent nursing and/or milk removal.

Galactogogues can be helpful at increasing supply, but ultimately other factors of nursing and/or milk removal should be addressed and optimized.

They should be used temporarily and tapered off once supply has been increased and maintained. If you have any questions regarding galactogogues and milk supply, please reach out to your trusted lactation professional for guidance.

Author Bio : Leslie Southard is a community retail pharmacist and certified lactation counselor in Omaha, Nebraska, USA. Her passion and lifelong goal is to share appropriate, up-to-date, and evidence-based information regarding medications and lactation. You can learn more about her and her services at www.thelactationpharmacist.com and on Facebook and Instagram as @thelactationpharmacist.

References

1. Hale TW. Hale’s Medications & Mothers’ Milk. 18th ed. Amarillo, TX: Springer Publishing Company; 2019.
2. Brodribb W. Academy of Breastfeeding Medicine. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018. Available at: https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/9galactogogues-protocol-english.pdf . Accessed June 16, 2019.
3. Tiran D. The use of fenugreek for breast feeding women. Complement Ther Nurs Midwifery. 2003 Aug:9(3):155-6. DOI: 10.1016/S135-6117(03)00044-1.
4. Estrella CP, Mantaring III JBV, David GZ, Trup MA. A double-blind, randomized controlled trial on the use of malunggay (Moringa oleigera) for augmentation of the volume of breastmilk among non-nursing mothers of preterm infants. 2000 Jan;49(1). https://www.moringatrees.org/moringadoc/moringa_breastfeeding_study.pdf
5. Sharma S, Ramji S, Kumari S, Bapna JS. Randomized controlled trial of Asparagus racietnosus (Shatavari) as a lactogogue in lactational inadequacy. Indian Pediatrics. 1996 Aug:33:675 https://pdfs.semanticscholar.org/3fed/d8bd2c541792c31dc21bfa9a4364ecba2c23.pdf .