Galactagogues in breastfeeding

Foods, herbs, and drugs that are believed to help boost maternal milk flow/production are called galactagogues. These are prescribed very frequently when breastfeeding is not going well, presuming that the maternal milk supply is low. In majority of the cases if the mother and baby dyad are helped with correct evaluation of latching and milk transfer from mother to baby, most of the challenges can be managed without drugs. Till now there are no conclusive studies on effectiveness of galactagogues and also often when galactagogues are prescribed, the cause of low milk supply is often overlooked. Before the use of a galactagogue, a lactation expert should thoroughly evaluate the entire feeding process and maximize the non-galactagogue management

Currently most commonly used prescription agents are dopamine receptor antagonists, primarily metoclopramide and domperidone. Both work by raising prolactin. Metoclopramide due to its propensity to cause extrapyramidal side effects and depression is the lesser preferred drug and should not be used longer than a few weeks or by anyone with a history of depression. Domperidone is the drug of choice at the moment, but this too needs to be prescribed with caution because of important concerns about arrhythmias due to QT prolongation. Fenugreek is the most widely used herbal agent. Reported side effects include diarrhea, flatulence, allergic reactions, and hypokalemia.

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