A Critical Review of Pharmaceutical Galactagogues

Abstract

Use of plant and drug products to enhance lactation is widespread, and numerous papers have been published in the medical literature claiming efficacy for various products. This paper will review and evaluate the published literature on the most widely used pharmaceuticals that are used as galactagogues. Breastfeeding physiology is reviewed with the aim of creating a framework for understanding galactagogue pharmacology. Published articles were selected and evaluated using the principles of evidence-based medicine, and were also evaluated using the principles of good lactation management. Only three studies on oxytocin and seven studies on dopamine antagonists were found to be useful. Oxytocin is probably not useful as a galactagogue, except possibly in rare circumstances of tetraplegic mothers. Dopamine antagonists appear not to enhance milk supply if mothers are given good lactation support and employ these practices. The safety of the dopamine antagonists has not been adequately evaluated, so their use should be avoided unless other measures have failed.

A cross-sectional descriptive study of breastfeeding behaviour and galactogogue use among private-sector patients in Cape Town, South Africa

“…[5] Galactogogues are dopamine antagonists such as antipsychotics, antiemetics and natural supplements which enhance lactation by increasing serum prolactin. [6] Galactogoguemediated rise in serum prolactin may transiently increase milk production, but after 2 weeks postpartum it has no effect on lactational performance. [5,7] A recent Cochrane review concluded that the use of galactogogues was not associated with a significant improvement in longer-term outcomes of breastfeeding in preterm infants.…”

Complementary and alternative therapies: supporting the woman with inadquate milk production

“…Understanding breastfeeding physiology is necessary to create a framework for understanding the role of herbal galactagogues, acupuncture, and effective lactation management (Anderson & Valdes, 2007). In order to incorporate galactagogues successfully in clinical practice, the process of milk production and infant feeding must be understood by the nurse practitioner or other primary care provider.…”

“…It has been shown to take 6 to 12 hours of effective breast emptying to reverse the effects of FIL and increase production again. Milk production is particularly sensitive to the effects of FIL during the first four weeks of breastfeeding (Anderson & Valdes, 2007;Czank, Henderson, Kent, Lai , & Hartmann, 2007;Wagner, 2009). …”

“…However, during the course of a normal lactation, prolactin levels continuously decrease, although they remain elevated from pre-pregnant levels as long as breastfeeding continues. It is now known that there is no direct correlation between prolactin levels and volume of milk produced (ABM, 2011;Anderson & Valdes, 2007;Hale, 2007;Hill et al, 2009). Milk production continues to occur as long as levels remain above the pre-pregnant baseline.…”

“…Milk composition changes, as lactose content and water content increase rapidly, resulting in increased milk secretion (Hurst, 2007). By the fifth postpartum day, milk production may be as high as 750 mLs/ day, then increasing to as much as IOOO mLs/ day by the second week of lactation (Anderson & Valdes, 2007). A delay in onset offull milk production has been observed in women with diabetes, following prolonged labor or stressful birth experiences, cesarean section delivery, or presence of retained placental fragments (Lawrence & Lawrence, 2011).…”