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Galactagogues

There is very limited research on the safety and effectiveness of taking an herb or medication to increase milk supply.   In addition, not all women have the ability to increase their low milk supply.  Prior to taking a galactagogue, MilkWorks highly recommends a feeding assessment by an IBCLC to identify causes and solutions.  When taking any galactagogue, remember that frequent milk removal is still the most important factor in milk supply.

Over the Counter Herbs/Plants

For centuries, a variety of herbs (plants) have been used around the world for milk supply.   Most have limited side effects, but they may interact with other medications. When effective, results are generally seen in 24-72 hours.

We suggest the following:

  • Do not exceed the recommended dose.
  • Stop a galactagogue immediately if you develop any sign of an allergic reaction, such as hives and/or wheezing.
  • Do not continue to take a galactagogue if you do not feel it is helping your milk supply.
  • Stop taking any galactagogue if your supply is adequate. Discontinue the herb gradually and watch how your supply responds.

FENUGREEK   Side effects: You may smell like maple syrup and have loose stools or gas. Large amounts may lower your blood sugar. Do not take if you are on any type of blood thinner* and use with caution if you have a thyroid condition* as fenugreek may lower T3 levels.  Fenugreek is a member of the legume family, so use with caution if you are allergic to peanuts or soybeans. Do not take during pregnancy*. Dose: 3 to 4 capsules (580-610 mg ea.) 3 to 4 times a day for a total of 9 to 16 capsules a day.

BLESSED THISTLE   Side effects: None commonly noted. Related to ragweed. Do not take during pregnancy.*

GOAT’S RUE   Side effects: None commonly noted. Like fenugreek, it is a member of the legume family. High doses may lower blood sugar levels.*

MORE MILK SPECIAL BLEND contains fenugreek, blessed thistle and goat’s rue, plus nettle and fennel to decrease possible stomach upset. Side effects: See information above on ingredients.  Nettle should not be consumed if you are taking a blood thinner* because it has a high vitamin K content.
Dose:  follow directions on bottle; dose varies with a mother’s weight.

GO LACTA (Malungaay or moringa oleifera) is a plant supplement that supports breast milk production. In developing countries, it is used as a food supplement because of its nutritional components. Small studies have shown that it can increase milk production.     
Side effects: None commonly noted.
Dose: follow directions on bottle, or 3 capsules 3 times a day for a total of 9 capsules a day.

Prescription Galactagogues

Unfortunately, there is no magic “pill” when it comes to increasing milk supply. Frequent milk removal is the most effective way to increase milk supply. When milk is left in the breast and not removed frequently, it suppresses milk production.

There are two prescription medications that are known to increase serum prolactin hormone levels, Reglan and Domperidone. We do not recommend Reglan because of its potential side effects, and Domperidone, which is monitored by the FDA for potential side effects, is not readily available in the U.S.

REGLAN (Metoclopramide) is a stomach motility medication that may increase milk supply. However, it commonly causes depression and fatigue, and may cause involuntary muscle spasms, called tardive dyskinesia, therefore we do not recommend using it.
Reglan has no officially established dosage for increasing milk supply. Most studies have used Reglan in a dosage of 10mg 2 or 3 times daily for 7 to 14 days. Some studies have used a tapering dosage for the last few days of treatment to avoid an abrupt drop in milk supply after drug discontinuation. No published literature supports the efficacy or safety of higher dosages, longer treatment periods or repeated courses of therapy.

DOMPERIDONE is also a stomach motility medication.  It is not approved for marketing in the United States by the US Food and Drug Administration because it is not manufactured here.  It is available in Canada and other countries. Nebraska’s Attorney General investigated practitioners prescribing domperidone via compounding pharmacies in 2006 and claimed that prescribing this medication is illegal as it is not an FDA approved drug. The FDA has also released a statement of concern about cardiac arrhythmias.  If mothers attempt to purchase the medication from outside the country, the package maybe confiscated at the border.  

  • The typical dosage for domperidone is 10 mg 3 times a day. Two small studies found no statistically significant additional increase in milk output with a dosage of 20 mg 3 times a day and that women who failed to respond to the lower dose did not respond to the higher dose either. Doses >30 mg a day may increase the risk of arrhythmias and sudden cardiac death in patients receiving domperidone.

For additional information about galactagogues, please see The Academy of Breastfeeding Medicine’s protocol at www.bfmed.org

or visit LACTMED, a free online National Library of Medicine data base at www.toxnet.nlm.nih.gov

February 2017