Prescription Medication to Improve Milk Supply

Should I ask my doctor for a prescription medication to help my milk supply?

In an earlier blog post I discussed the use of herbal teas or supplements to increase milk supply. This time I will look at how prescription medications might play a role in the management of milk supply issues.

Substances that are taken to increase milk supply, whether they are herbal supplements or prescribed medications are known as “galactogogues”. In deciding to use either, it is first important to evaluate whether the milk supply is actually low and why it has decreased.

The most common cause of a low milk supply is insufficient emptying of the breasts. Be sure that you are feeding your baby as often as the baby asks to be fed when you are with your baby. When separated from your baby at feeding times, be sure to use a good quality breast pump to empty your breasts thoroughly at least every 3 to 4 hours. Remember the basic principle that the body makes milk in response to the amount of milk removed. A baby will ask to feed more often when they are signaling the mother’s body to produce more milk. Increasing the frequency of feedings and/or pumping sessions for a few days will usually lead to an increased milk supply.

Even breastfed babies between 4 to 6 months of age seldom ask to take more than 6 ounces of milk at a feeding. If your day care is asking for more than this amount of milk, you may need to review the feeding schedule to see if they might be misinterpreting your baby’s cues. After 6 months of age, solid foods are introduced into the diet and make up part of the baby’s caloric intake for the day.

So when should you think about asking for a prescribed galactogogue? According to the Academy of Breastfeeding Medicine, “Use of galactogogues for faltering milk supply should generally be reserved for situations after both a thorough evaluation for treatable causes (e.g., maternal hypothyroidism or medication) and increased frequency of breastfeeding or pumping or expression has not been successful.” It is important to remember that all medications have potential side effects and the possibility of developing a negative side effect must be weighed against the potential benefit of the medication. Once your health care provider has helped you rule out a treatable cause of low milk supply and your lactation consultant has assisted you in improving lactation management, a decision may be made to try a prescribed galactogogue.

In this country, the most commonly prescribed galactogogue is metoclopramide which is sold under the trade name Reglan. Raglan promotes lactation by antagonizing the release of dopamine in the central nervous system, thereby increasing prolactin levels (prolactin promotes milk production). It is also used for controlling the symptoms of esophageal reflux in both infants and adults. Reglan does not alter milk composition and it has been shown to augment milk supply in a number of scientific studies.

There are a number of side effects that mothers can experience when taking Reglan including restlessness, drowsiness, fatigue and diarrhea. Less common but more severe side effects can include sleeplessness, headache, confusion, dizziness, mental depression, or feelings of anxiety or agitation. Concern about the possible development of one of these side effects has lead most clinicians to prescribe Reglan for short periods of time. The Academy of Breastfeeding Medicine cautions that Reglan should not be used if patients have epilepsy or are on antiseizure medications, have a history of significant depression or are on antidepressant drugs, have uncontrolled hypertension, intestinal bleeding or obstruction, or have a known allergy or prior reaction to Reglan. They also state that Reglan does transfer into the milk, but research has demonstrated no side effects in the infants of mothers taking this medication.

Domperidome is another dopamine antagonist that is available outside the United States for treatment of esophageal reflux. According to the Academy of Breastfeeding Medicine its drug characteristics make it less likely to cross the maternal blood-brain barrier, resulting in less nervous system related side effects than metoclopramide. Domperidone is also less likely than metoclopramide to cross into the breast milk. Administration of domperidone results in significant increases in prolactin levels and it is the only galactogogue evaluated in a randomized controlled trial and shown to be safe and effective in increasing breast milk production. Side effects are very uncommon and include dry mouth, headache (resolved with decreased dosage), and abdominal cramps. Unfortunately, despite its safe use in many other countries, domperidome has not been approved for use in the United States by the U.S. Food and Drug Administration.

Prescribed galactogogues are available to help improve milk supply but need to be used with caution, and only on the recommendation of a health care provider who will monitor the reactions of both mother and baby. Before consideration is given to medication, all other efforts should be made to identify and resolve modifiable causes of low milk supply.

Additional information about use of prescribed galactogogues is available at The Academy of Breastfeeding Medicine website under their protocols section.

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