Drug therapy for insufficient milk supply
Many mothers who express milk for premature or sick babies have problems maintaining milk supply. This might be due to fatigue, stress, irregular breast emptying, and other factors that a mother cannot control . We teach mothers a number of supportive measures, which focus on enhancing let down reflexes, and frequent effective breast emptying. Some mothers ask to pursue drug therapy for this problem, and we offer these recommendations.
Metoclopramide (Reglan) may increase milk volume when used with a routine of rest and frequent milk expression. Metoclopramide has been studied for milk production in research trials, including studies of mothers of premature babies. (1) We consider it safe for the infant during breastfeeding. The recommended treatment with metoclopramide is a 12 day course, using the following prescription: metoclopramide 10 mg tablets #30 on the following schedule: Day 1: 1 tablet, Day 2: 1 tablet twice a day, Day 3-10: 1 tablet three times a day, Day 11: 1 tablet, Day 12: 1 tablet.
The slow increase in dosage allows mothers to assess possible problems with sedation, abdominal cramping or diarrhea . Increase in milk volume is usually noticeable by Day 3. Mothers keep a pumping journal to help assess efficacy. The slow decrease in dosage allows assessment of drug effect, and may help in the decision to continue therapy. Monitoring should include assessment of maternal mental health, since depression can occur, particularly with an extended course of treatment.
Domperidone (Motilium) is a second prescription galactogogue . It is also a prokinetic GI agent. The effect on lactation was noticed as a side effect. It can raise prolactin levels markedly, even in women who are not post-partum. It has been studied in premature babies. (2) It does not carry the risk of depression that is associated with metoclopramide, and for that reason some experts regard it as a preferred therapy. (3) The American Academy of Pediatrics has it on the “safe during breastfeeding” list . However, in high doses, the intravenous form of the drug has caused heart rhythm problems, which lead the US Food and Drug Administration to deny approval to marketing commercial domperidone. A full discussion of this issue can be found at http://www.breastfeedingonline.com/domperidone.shtml The balance of risk and benefit needs to be assessed by each mother who is considering domperidone therapy.
Domperidone as a galactogogue may be taken as 10-20 mg 3-4 times a day. Increases in milk supply are usually seen within 48 hours. Side effects are infrequent but would include abdominal pain or cramping, or frequent stools .
Compounding pharmacies can fill prescriptions for domperidone . One option is:
Specialty Pharmacy
623 North New Ballas Road (North of SJMMC on Ballas, south of Olive, west side of street)
Erin Thomas, RPh or Lee Ori, RPh 314 991 5200 phone 314 991 5210 fax
Another option is to order the medication from a Canadian pharmacy. A written prescription is faxed to the Canadian pharmacy, and the rest of the transaction is completed via the Internet. There are many choices, and we can help mothers choose a reputable Canadian pharmacy .
We direct mothers to collaborate with their obstetrician or primary care doctor to assess possible drug interactions or contraindications to prescription galactogogue therapy. We’re glad to answer questions or provide copies of studies on this treatment . Kelly Burch, PharmD August 2007
- Ehrenkranz RA, Ackerman BA. Metoclopramide effect on faltering milk production by mothers of premature infants. Pediatrics 1986;78:614-20.
- da Silva OP, Knoppert DC, Angelini MM, Forrest PA. Effect of domperidone on milk production in mothers of premature newborns: A randomized, double-blind, placebo controlled trial. CMAJ 2001;164:17-21.
- Hale TW, Berens P. “Insufficient Milk Supply” in Clinical Therapy in Breastfeeding Patients Pharmasoft Publishers 2 nd edition 2002.
