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Should You Take Prescription Meds to Increase Breastmilk Supply?

To finish up Galactagogue Week, I'm writing about prescription medications to increase milk supply.

Again, I want to point anyone looking to increase her milk supply to this podcast on making more milk, for a list of the many things to do before, or while, taking a galactagogue. And remember that there are many things that might lead you to think that your supply is low when it isn't. The podcast discusses this also.

This is a challenging topic to write about, and frankly I've been hesitant to write about it until now.

Here's the scoop:* There are two prescription medications known to increase milk supply.  One has a complicated status and the other has side effect problems when used for this purpose.

The first, domperidone (brand name Motilium) is a highly effective galactagogue. It's an anti-reflux drug that has the side effect of increasing milk supply. Prescribing it for that purpose is considered an "off label" use. It is available over-the-counter in the UK and other countries, but by prescription only in the US, and it must be ordered at a compounding pharmacy. Domperidone does not have the side effect I discuss below with respect to Reglan.

Medications and Mothers' Milk says domperidone is "considered the ideal galactagogue," and labels it an "L1" on the L1 to L5 scale, placing it in the "Safest" category. The American Academy of Pediatrics rates it as "usually compatible with breastfeeding."

In 2004 the Food and Drug Administration issued a warning that domperidone could induce arrhythmias in patients. Medications and Mothers' Milk states, "These claims were derived from data many years old where domperidone was used intravenously as an antiemetic during cancer chemotherapy.  Many of these patients were undergoing extensive chemotherapy, were extremely ill, and hypokalemic to begin with. In addition, intravenous domperidone produces plasma levels many times higher than oral use. Thus far, we do not have any recent published data suggesting that domperidone used orally in breastfeeding mothers is arrhythmogenic, although its use in women who are already arrhythmic is not recommended."

Because of this there is a lot of confusion about domperidone, and it's rarely prescribed here. I've found providers much more likely to prescribe the other drug, Metoclopramide, but this involves other problems.

Like domperidone, Metoclopramide (brand name Reglan) increases milk supply, and is also an anti-reflux drug used "off label" in nursing mothers to increase milk supply.  It's available by prescription only in the U.S. 

Medications and Mothers' Milk labels it an "L2" on the L1 to L5 scale. The American Academy of Pediatrics rates it as a drug "whose effect on nursing infants is unknown but may be of concern."

But here are the main concerns: Metoclopramide cannot be taken long term (more than four weeks) because, according to Medications and Mothers' Milk, it can cause side effects such as "depression in the mother." The book also states that "on rapid discontinuation of the medication, the supply of milk may in some instances reduce significantly." The book also notes that "the FDA has recently warned of symptoms of tardive dyskinesia after 3 months of exposure,"

There are other factors to consider, and I encourage you to research further, but can you already see how messy this is? Feel free to chime in with your own experiences.

*This information is provided for educational purposes only and is not medical advice.  Readers should consult with their health care providers for care suited to their individual needs.

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