ArticlePDF AvailableLiterature Review

The Use of Galactogogues in the Breastfeeding Mother


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To review data regarding the efficacy of galactogogues available in the US to increase breast milk production in postpartum mothers. Literature was sought using PubMed (1966-June 2012) and EMBASE (1973-June 2012). Search terms included breastfeeding, breast milk, lactation, galactogogue, metoclopramide, oxytocin, fenugreek, milk thistle, silymarin, growth hormone, thyroid releasing hormone, medroxyprogesterone, domperidone, goat's rue, beer, Asparagus racemosus, shatavari, Medicago sativa, alfalfa, Onicus benedictus, blessed thistle, Galega officinalis, brewer's yeast, and herbals. All studies including humans and published in English with data assessing the efficacy of galactogogues for increasing breast milk production were evaluated. Breast milk is considered the optimal food source for newborns through 1 year of age. Many factors influence overall maternal production, including maternal pain, illness, balance of time when returning to work, anxiety, or emotional stress. Although a variety of herbal and pharmaceutical options have anecdotal evidence of their ability to improve breast milk production, peer-reviewed studies proving their efficacy are lacking. Metoclopramide, oxytocin, fenugreek, and milk thistle have shown mixed results in improving milk production; however, the trials were small and had a variety of limitations. Nonpharmacologic recommendations should be exhausted before adding therapy. Although anecdotal evidence encourages the use of metoclopramide, fenugreek, asparagus, and milk thistle for their galactogogue properties, efficacy and safety data in the literature are lacking. Oxytocin and domperidone are potentially available for compounding purposes, but safety data are limited. More studies are needed to evaluate the effects of available galactogogues on breast milk production.
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1392 nThe Annals of Pharmacotherapy n2012 October, Volume 46
Breastfeeding is considered the opti-
mal source of nutrition for infants
from birth to 1 year and is supported by
the American Academy of Pediatrics
(AAP) and the World Health Organiza-
tion.1,2 The 2012 AAP Policy on Breast-
feeding recommends exclusive breast-
feeding for 6 months, with continuation
up to 1 year or longer.Breastfeeding has
been associated with both short- and
long-term benefits over formula feeding.
In 2007, the Agency for Healthcare Re-
search and Quality prepared a report
summarizing the literature concerning
the relationship between breastfeeding
and its impact on infant and maternal
outcomes.3Atotal of 9000 abstracts
were reviewed; 43 studies focused on in-
fant health outcomes, 43 studies on ma-
ternal health outcomes, and 29 systemat-
ic reviews or meta-analyses of more than
400 trials. Results of these studies indi-
cated that exclusive breastfeeding for a
minimum of 3 months decreased the risk
of the infant developing acute otitis me-
dia and/or atopic dermatitis and, if the
child were exclusively breastfed for
greater than 4 months, the result was a
decrease in hospitalizations secondary to
lower respiratory tract infection. Addi-
tionally, if breastfeeding continued for greater than 6
months, there was a potential decrease in the occurrence of
acute lymphocytic leukemia and acute myeloid leukemia.
Studies have also shown a potential decrease in death from
sudden infant death syndrome and the development of
asthma, diabetes mellitus, and obesity. The Agency for
Healthcare Research and Quality report also notes the po-
tential benefits to the mother, including reduced risk of
breast and ovarian cancers as well as decreased risk of dia-
betes mellitus type 2 as long as the mother did not have
gestational diabetes.
Despite the AAP recommendations and perceived bene-
fits, breastfeeding rates in the US continue to be low.4At
The Use of Galactogogues in the Breastfeeding Mother
Alicia B Forinash, Abigail M Yancey, Kylie N Barnes, and Thomas D Myles
Author information provided at end of text.
OBJECTIVE:To review data regarding the efficacy of galactogogues available in
the US to increase breast milk production in postpartum mothers.
DATA SOURCES:Literature was sought using PubMed (1966-June 2012) and
EMBASE (1973-June 2012). Search terms included breastfeeding, breast milk,
lactation, galactogogue, metoclopramide, oxytocin, fenugreek, milk thistle, silymarin,
growth hormone, thyroid releasing hormone, medroxyprogesterone, domperidone,
goat’s rue, beer,
Asparagus racemosus
Medicago sativa
,blessed thistle,
Galega officinalis
,brewer’s yeast, and herbals.
STUDY SELECTION AND DATA EXTRACTION:All studies including humans and pub-
lished in English with data assessing the efficacy of galactogogues for increasing
breast milk production were evaluated.
DATA SYNTHESIS:Breast milk is considered the optimal food source for newborns
through 1 year of age. Many factors influence overall maternal production, including
maternal pain, illness, balance of time when returning to work, anxiety, or emo-
tional stress. Although a variety of herbal and pharmaceutical options have
anecdotal evidence of their ability to improve breast milk production, peer-
reviewed studies proving their efficacy are lacking. Metoclopramide, oxytocin,
fenugreek, and milk thistle have shown mixed results in improving milk produc-
tion; however,the trials were small and had a variety of limitations.
CONCLUSIONS:Nonpharmacologic recommendations should be exhausted
before adding therapy.Although anecdotal evidence encourages the use of
metoclopramide, fenugreek, asparagus, and milk thistle for their galactogogue
properties, efficacy and safety data in the literature are lacking. Oxytocin and
domperidone are potentially available for compounding purposes, but safety data
are limited. More studies are needed to evaluate the effects of available
galactogogues on breast milk production.
KEY WORDS:breastfeeding, breast milk, fenugreek, galactogogue, herbals,
lactation, metoclopramide, milk thistle, oxytocin, silymarin.
Ann Pharmacother
Published Online, 25 Sept 2012,
,doi: 10.1345/aph.1R167
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birth, initiation of breastfeeding occurs for 75% of moth-
ers; however, the rate of breastfeeding decreases to 44.6%
at 6 months and 23.8% at 12 months. Exclusive breast-
feeding rates are even lower at 35% and 14.8% at 3
months and 6 months, respectively. Many factors can con-
tribute to difficulty feeding and may lead to early cessation
of breastfeeding; these include structural abnormalities
such as inverted nipples and oral clefts, infection, pain,
poor latching, and insufficient milk production.5Factors
that have been associated with a reduction in breast milk
production include preterm delivery, maternal illness, anxi-
ety, fatigue, and emotional stress. Because of the many
documented benefits of continued breastfeeding for the in-
fant and mother, different measures are taken to increase
breast milk production. A variety of herbal and pharma-
ceutical products have been recommended as galacto-
gogues, substances that promote lactation. The purpose of
this article is to review data regarding the efficacy of galac-
togogues available in the US for increasing breast milk
production in postpartum mothers.
Physiology of Breastfeeding
Many factors play a role in the development of breast
milk. During early pregnancy, estrogen and progesterone
develop key components of the breast tissue for lactation;
estrogen stimulates milk duct development and proges-
terone forms lobules that are responsible for milk produc-
tion. Prolactin is the predominant hormone that stimulates
mammary glands; however, high progesterone and estro-
gen progesterone levels during pregnancy suppress pro-
lactin’saction on milk production during pregnancy.Addi-
tionally,prolactin and human chorionic somatomam-
motropin stimulate the production of enzymes required for
milk production. After delivery,estrogen and progesterone
levels significantly decrease, allowing prolactin to fully
stimulate the alveoli for milk production. Cortisol, insulin,
vasoactive intestinal peptide, growth hormone, and thy-
roid-releasing hormone stimulate prolactin and influence
the composition of milk, whereas dopamine inhibits pro-
lactin, suppressing its action.6,7 Milk secretion is primarily
controlled by oxytocin, which stimulates the myoepithelial
cells to contract and release stored milk into the ducts (ie,
letdown). Milk must be ejected from the lumen of the alve-
oli into the milk ducts to reach the infant. Infant suckling
stimulates production of prolactin as well as oxytocin.
Milk secretion continues until suckling ends. Interestingly,
even if the alveoli still contain milk, once suckling stops,
no more milk can be released. It is important to allow plen-
ty of time for feeding or breast pumping to empty the
breasts. When all of the milk is released, the breast stimu-
lates additional milk production for the next feeding. This
feedback mechanism leads to an overall increase in supply
over time.6,7
Literature Selection
Asearch of PubMed (1966-June 2012) and EMBASE
(1973-June 2012) was performed with the terms breastfeed-
ing, breast milk, lactation, galactogogue, metoclopramide,
oxytocin, fenugreek, milk thistle, silymarin, growth hormone,
thyroid-releasing hormone, medroxyprogesterone, domperi-
done, goat’s rue, beer, Asparagus racemosus,shatavari, Med-
icago sativa,alfalfa, Onicus benedictus,blessed thistle, Gale-
ga officinalis,brewer’s yeast, and herbals. Limits of English
language and human subjects were applied to the searches.
References of all articles were reviewed to identify additional
relevant articles. All relevant articles were included despite
limitations due to the limited supply of published data evalu-
ating these therapies. These products are commonly recom-
mended in practice by both maternal and pediatric health care
providers. Case reports, case series, and abstracts were ex-
cluded unless they were the only published literature on the
topic. Medications that are not available in the US were ex-
cluded from this review.
Herbal Products
Natural herbal medications, such as fenugreek (Trigo-
nella foenum-graecum), milk thistle (silymarin; Silybum
marianum), A. racemosus (shatavari), alfalfa (M. sativa),
blessed thistle (O. benedictus), goat’s rue (G. officinalis),
fennel (F.vulgare), and brewersyeast, are often recom-
mended to breastfeeding mothers to increase milk produc-
tion. However, data on herbal products are limited and of-
ten based on anecdotal evidence. Fenugreek, milk thistle,
and asparagus are frequently recommended and are the
only herbal galactogogues that have some, although mini-
mal, published clinical data on use in humans.8,9
Fenugreek is a member of the pea family and is often
used as artificial maple flavoring.10 The galactogogue prop-
erty of fenugreek was first reported in the 1940s. Although
its exact mechanism of action is unknown, there are 2 pro-
posed mechanisms. The first is that it increases sweat pro-
duction, leading to an increase in milk supply given that
the breast is considered to be a modified sweat gland (Fig-
ure 1).10,11The second thought is that milk flow is increased
by fenugreek phytoestrogens and diosgenin, a steroid sa-
pogenin, components.12 The recommended dose of fenu-
greek is 2-3capsules (580-610 mg per capsule) 3- 4 times
per day, and it may be discontinued once milk supply has
increased to the desired level.10,11Many women have re-
ported results within 24-72 hours.8,10,11
Fenugreek is often prescribed to nursing mothers, based
on anecdotal reports. One physician observed the success-
ful use of fenugreek in more than 1200 patients. Unfortu-
The Annals of Pharmacotherapy n2012 October, Volume 46 n1393
nately, detailed information was not available in regard to
gestational age, time of initiation, or specific results.10 Two
studies showed that fenugreek appears to stimulate breast
milk production (Table 1).12-14 Limitations of these reports
include lack of reporting maternal and infant adverse ef-
fects, adherence, and doses of fenugreek used. Confound-
ing factors that affect breastfeeding success, including
caloric and fluid intake of mother, other medications used,
frequency and duration of breastfeeding, and stress/pain
level of the mother, were not controlled in these studies.
One study evaluating 10 exclusively pumping women was
presented only in abstract form; full evaluation of the data
is therefore not possible.13 The second study, a randomized
trial, also included a small sample size and focused mainly
on birth weight, loss of birth weight, and time to regain
birth weight.12 Milk volume produced was measured only
on the third day after delivery and the study concluded
when the infant reached birth weight, so the full efficacy of
fenugreek was unable to be determined. The biggest limi-
tation of this study is that the galactogogue tea included
other herbal components thought to have galactogogue
properties, including fennel and goat’s rue; thus, it is diffi-
cult to conclude that benefit is solely from fenugreek.12,15
Although it appears that fenugreek may have some bene-
fit, randomized clinical trials are needed to determine its spe-
cific role as a galactogogue. Safety data are minimal since ad-
verse events and tolerability were not reported. Currently, the
Food and Drug Administration (FDA) lists fenugreek as gen-
erally regarded as safe (GRAS); however, these data are not
specifically aimed at the nursing mother and infant.10,16 Addi-
tionally, no information has been published to describe the
safety or relative infant dose of fenugreek consumption
through breast milk. There are reports of mild gastrointestinal
symptoms in the mother, mainly diarrhea, and there is poten-
tial for hypoglycemic effects.10,11 The fenugreek seed can lead
to a maple-like odor that can be mistaken in infants for
maple-syrup urine disease, which is a metabolism disorder in
which the body is unable to break down certain parts of pro-
teins.9,17 Women who are pregnant should not use fenugreek,
as it has been shown to stimulate uterine contractions.8,16
Another popular herbal galactogogue is milk thistle (sily-
marin, St. Mary’s milk), which has been used for more than
2000 years for a variety of ailments.18 It is theorized that milk
thistle galactogogue effects are secondary to an increase in
prolactin levels, as seen in female rats (Figure 1).19 Clinical
data are limited to 1 placebo-controlled trial14 conducted in
Peru (Table 1).12-14 Limitations of this study include a small
sample size, indirect measurement of milk production by
weighing the infant before and after feeding, as well as not
1394 nThe Annals of Pharmacotherapy n2012 October, Volume 46
AB Forinash et al.
Figure 1. Physiology of lactation and potential medication mechanisms of action. PIH = prolactin inhibiting hormone; PRH = prolactin releasing hormone.
aExact mechanism of action unknown but known to increase prolactin.
including detailed information on both the mother and in-
fants, infant weight gain, adverse event data, and adherence.
Randomized controlled trials evaluating the benefit of milk
thistle are needed to show its benefit, safety, and potential role
as a galactogogue. As with many herbal agents, safety data
are minimal and, unlike fenugreek, milk thistle is not listed as
GRAS by the FDA. No data are available describing the rela-
tive infant dose of milk thistle after breast milk consump-
Shatavari is a popular galactogogue used in India. The
exact mechanism of action is unknown but could possibly
be secondary to the presence of steroidal saponins, which
potentially increase prolactin levels.20 Two studies have
been conducted to determine whether prolactin increased
with shatavari; unfortunately, the results were conflict-
ing.20,21 Both studies looked at milk production as a sec-
ondary outcome; however, this was determined indirectly
by weighing the infant before and after treatment. Once
again, study results were conflicting. Other limitations of
the trials included small sample size, omission of detailed
information on adherence, reasons for drop-outs, and in-
formation about adverse events for both mother and infant.
As with milk thistle, shatavari is not listed as GRAS by the
FDA.22 There is also recent evidence showing teratogenicity
in animal studies, thus shatavari should be avoided in preg-
nant females.23 No data are available describing relative in-
fant dose of shatavari after breast milk consumption.22,23
Randomized controlled trials are needed to determine the
benefit, safety, and potential role as a galactogogue.
Potentially Available from Compounding
Before oxytocin nasal spray was voluntarily removed
from the US market in 1995 and worldwide in 1999, it was
commonly used to promote milk letdown in women with
decreased milk production. Supplemental oxytocin in-
creased breast milk production because it causes contraction
of the myoepithelial cells that surround areola tissue in the
breast (Figure 1).24 Three randomized, double-blind studies
have been conducted evaluating the impact of oxytocin nasal
spray immediately prior to each breastfeeding session to in-
crease breast milk production (Table 2).25-31 Oxytocin nasal
spray 3 IU per spray prior to each feeding from birth to 5
days postpartum showed significant differences in overall
breast milk production. Production increased 3- to 5-fold
with oxytocin nasal spray compared with placebo in primi-
parous mothers and 2-fold in multiparous mothers.
Oxytocin appears to be generally well tolerated, but minor
epistaxis was reported by 1 woman in 1 study.25 No infant ad-
verse events were reported; however,safety cannot be as-
sumed since only a small number of exposures occurred.
Limitations of these studies include small sample size, short
duration, minimal to no information on infant weight gain re-
ported, evaluated only the effects in preterm delivery, and
overall medication adherence was not verified.24-27 The first
trial also used an indirect method for measuring production
by breast engorgement instead of actual milk production.25
Overall, oxytocin improved milk production when used in
late preterm deliveries compared with historical controls but
The Use of Galactogogues in the Breastfeeding Mother
The Annals of Pharmacotherapy n2012 October, Volume 46 n1395
Table 1. Comparison of Herbal Galactogogue Clinical Trialsa
Age Milk Effect on Infant
Reference Regimen Patients (FT/PT) Attainment Milk Production Weight
Turkyilmaz Fenugreek tea, Fenugreek tea (n = 22) 1 day Nursing, except day 3 Day 3 postdelivery: fenugreek Lactation
201112 3cups daily Control (n = 22) (FT) postdelivery by 73.2 ± 53.5 mL; control consultant for all
Placebo (n = 22) mechanical breast pump 38.8 ± 16.3 mL; placebo groups
31.1 ± 12.9 mL (p = 0.004)
7.3 ± 2.7 mL; placebo
9.9 ± 3.5 mL
Swafford Fenugreek 10 Breast pump Daily average increase from
200013 3capsules 207 to 464 mL (p = 0.004)
Di Pierro Micronized Milk thistle (n = 25) Nursing, then pumping to Milk thistle 601.92 mL (day 0),
200814 milk thistle Control (n = 25) void the gland 989.76 mL (day 30), and
420 mg/day 1119.24 mL (day 60); an
for 63 days 85.95% increase
Placebo 530.36 mL (day 0),
649.76 mL (day 30),
700.56 mL (day 60); a
32.09% increase
FT = full-term delivery; PT = preterm delivery.
aNo data have been reported on maternal or infant adverse events.
1396 nThe Annals of Pharmacotherapy n2012 October, Volume 46
AB Forinash et al.
Table 2. Comparison of Clinical Trials with Prescription Products
Age Milk Infant Maternal Infant
Reference Regimen Patients (FT/PT) Attainment Effect on Milk Production Weight ADRs ADRs Notes
Oxytocin Nasal Spray (within 5 minutes prior to each pump)
Huntingford Oxytocin Oxytocin Day 1 Milk production day 7: oxytocin, mean Day 4: Minor epistaxis Oxytocin 4-5 IU (no spray amount provided)
196125 before (n = 24) (unknown 3.4 oz; placebo, mean 2.3 oz Oxytocin, (n = 1) Randomized, double-blind
feeding Placebo whether (p < 0.001) –147 g Average length of use: oxytocin 70 hours
for up to (n = 24) FT/PT) Placebo, (before 14 feedings); placebo 78 hours
10 days –207 g (before 16 feedings)
(p = 0.01) No significant difference in primary outcome
of level of breast engorgement (clinical
Ruis Oxytocin Oxytocin Day 1 Pump Primiparous: 3- to 5-fold increase Oxytocin 3 IU 1 spray, pump 10 minutes,
198126 before (n = 8) (PT) Multiparous: 2-fold increase instill 2 sprays, pump 10 minutes, repeat
pumping for Placebo Oxytocin: 1964 ±308 mL for other breast
5 days (n = 4) Placebo: 510 ±142 mL Randomized, double-blind
(p = 0.0002) Gestation age <38 weeks
Fewtrell Oxytocin prior Oxytocin (PT) Pump every Day 5: None None Oxytocin 100 µL (~4 IU/dose)
200627 to pumping (n = 27) 3 hours Oxytocin median 667 g Randomized, double-blind, intention-to-
for 5 days Placebo Placebo median 530 g treat, maintained 80% power
(n = 24) (p = 0.9) Mean gestational age 29 weeks
Received education on lactation
Campbell- Domperidone Domperidone 3-4 weeks Pump Baseline to 14-day milk volume: Domperidone: none None Gestational age <31 weeks
Yeo 201028 10 mg 3 (n = 22) (PT) Domperidone 184.4-380.2 mL Milk volume increased within 48 hours
times/day Placebo (266.8%)
or placebo (n = 24) Placebo 217.7-250.8 mL (18.5%)
for 2 weeks p < 0.005
Wan Domperidone: Domperidone 16-117 Pump Baseline: mean 8.7 g/h–1 Abdominal cramps Conducted in Australia
200829 10 mg 3 (n = 6) days 30 mg: mean 23.6 g/h–1 (p = 0.0217) (30 mg: 1; 60 mg: 2) Randomized, double-blind
times/day or (mean 53) 60 mg: mean 29.4 g/h–1 (p = 0.0047) Constipation (60 mg: 1) Gestational age, mean 26.5 weeks
20 mg 3 (PT) Dry mouth (30 mg: 3; (24-29.4)
times/day 60 mg: 5) 2 nonresponders
for 2 weeks Depressed mood
Crossover (60 mg: 1)
Headache (30 mg: 1;
60 mg: 3)
da Silva Domperidone Domperidone Mean 31- Pump Domperidone: 112.8 mL to 162.2 mL None None Conducted in Canada
200130 10 mg 3 (n = 11) 33 days (44.5%; p < 0.05) Randomized, double-blind
times/day Placebo (PT) Placebo: 48.2 mL to 56.1 mL (16.6%) Gestational age mean, 29.1 weeks
for 1 week (n = 9)
no improvement in early preterm deliveries compared with
Currently, oxytocin is available in intramuscular and intra-
venous injection forms in the US; however, it lacks the indi-
cation for lactation purposes. Oxytocin powder is still avail-
able for compounding pharmacies and could potentially be
used as a galactogogue. Available data do not describe the
relative infant dose and theoretical infant dose in breast
In addition to oxytocin, domperidone is a potential galac-
togogue available in powder formulation for potential com-
pounding. Domperidone is a dopamine antagonist and can
increase prolactin levels (Figure 1). Domperidone 10 mg
orally every 8 hours for 2 weeks has been shown to increase
milk supply in 48 hours, and it has a low relative infant dose
of 0.04% and a subtherapeutic theoretical infant dose of 0.18
µg/kg/day.28-31,33 Domperidone significantly increased milk
production in women with preterm deliveries (Table 2).25-31 It
appears to be generally well tolerated, but abdominal cramps,
headaches, constipation, and depression have been reported,
although rates were higher when the dose was increased to
20 mg every 8 hours. No infant adverse events were reported;
however, safety cannot be assumed since only a small num-
ber of exposures occurred. Limitations of these domperidone
studies include small sample size; location, having been con-
ducted in other countries; and potential confounders that may
have affected milk supply, such as fluid and calorie intake,
frequency of pumping, medical history, and concomitant
medications, were not provided.
Despite effectiveness, this formerly commercially avail-
able product was removed from the market in 2004. The
FDA released a statement expressing concerns for dom-
peridone safety in lactating women due to potential for car-
diac arrhythmias and sudden cardiac death in 2004 and
again in 2009.34,35 This risk was discovered in oncology pa-
tients with hypokalemia receiving intravenous domperi-
done; however, the FDA issued warnings specific to lactat-
ing mothers to avoid the use of domperidone.
Prescription Products
Metoclopramide is a commonly prescribed galactogogue
that acts through dopamine antagonism to increase pro-
lactin levels and stimulate increased milk production (Fig-
ure 1).36-41 In one study, milk supply increased 52% after 2
days of treatment.38 Metoclopramide has been studied as 10
mg given orally 3 times a day for 5 days to 4 weeks, but
most commonly 7-14 days, initiated with onset of lactation
or later for partial or complete lactation failure in both
preterm and full-term infants (Table 3).36-48 Metoclopramide
The Use of Galactogogues in the Breastfeeding Mother
The Annals of Pharmacotherapy n2012 October, Volume 46 n1397
Petraglia Domperidone Group A: Group A: Nursing Domperidone: day 2, 347 ±36 mL None None Group A: history of lactation problems
198531 10 mg 3 Domperidone 2 days Placebo: day 2, 335 ±30 mL Group B: Primiparous with insufficient
times/day (n = 8) lactation after 2 weeks
for 3-10 Placebo Feedings 6-7 times/day
days (n = 7) Infants weighed pre- and postfeedings
Group B: Group B: Domperidone: day 10, 673 ±44 mL to determine milk amount
Domperidone 2 weeks Placebo: day 10, 398 ±45 mL (p < 0.01) Milk supply significantly higher with
(n = 9) Group A: domperidone vs placebo at days 4, 6, 8,
Placebo Domperidone: day 2, 105 ±35 mL and 10
(n = 8) Domperidone: day 5, 475 ±51 mL
(p < 0.05)
Group B:
Domperidone: day 2, 371-417 mL; day
5, 631-708 mL
ADRs = adverse drug reactions; FT = full-term delivery; PT = preterm delivery.
1398 nThe Annals of Pharmacotherapy n2012 October, Volume 46
AB Forinash et al.
Table 3. Comparison of Metoclopramide Clinical Trials
Metoclopramide Age Milk Effect on Maternal Infant
Reference Regimen Patients (FT/PT) Attainment Milk Production Infant Weight ADRs ADRs Notes
Guzman 10 mg 2 times/ Metoclopramide 2 days (FT) Data not collected; considered All had history of decreased
197936 day for 4 weeks (n = 11) good for all groups; lactation
Placebo (n = 10) supplemental formula not Metoclopramide group started
who could start needed medications before starting
metoclopramide lactation
during week 2
Control (n = 30)
Ertl 199137 10 mg 3 times/day Metoclopramide 1 day (FT) Not noted; milk No baseline values Pumping or weighing of babies
for 5 days (n = 11) samples by Day 5: metoclopramide,
Placebo (n = 11) expression 276.4 ±36.6 mL; placebo,
150.0 ±25.3 mL (p < 0.01)
Ehrenkranz 10 mg 3 times/day Metoclopramide 32 ±3.7 Electrical or Metoclopramide 93.3 ±18 mL Diarrhea (1), None All babies premature; mean
198638 for 7 days, then (n = 17) days (PT) hand breast (day 1) to 197.4 ±23 mL nervousness (1), gestational age 30.4 ±0.7 weeks
tapered over 2 pump (day 7) (p < 0.001) tiredness (1)
Kauppila 5, 10, or 15 mg 5 mg (n = 10) 8-62 days Nursing 5 mg: 12.1 mL (92.4 vs 104.5) 5 mg: 380 ±153 g Tiredness (1), Crossover vs placebo for each
198139 3 times/day for 10 mg (n = 13) (FT) Placebo: 4.4 mL (96.8 vs 92.4) Placebo: 331 ±144 g headache (1), strength of metoclopramide
2 weeks 15 mg (n = 14) 10 mg: 42.5 mL (96.3 vs 138.8) 10 mg: 439 ±143 g anxiety (1), Lactational response measured
(p < 0.001) Placebo: 385 ±132 g hair loss (2), by weighing infant
Placebo: 10.5 mL (96.3 vs 15 mg: 480 ±138 g intestinal –8 dropouts
106.8) Placebo: 449 ±162 g disorders (2)
15 mg: 50 mL (80.3 vs 130.3)
(p < 0.05)
Placebo: –0.3 mL (80.3 vs 80)
Kauppila 10 mg 3 times/day (n = 17) 18-141 Nursing Baseline vs end of treatment Baseline, mean 4653 g Tired (5), nausea Gas (1)
198140 for 3 weeks, offdays First treatment: 194 mL Gain, mean 5%/week (2), headache
1 week, repeat (mean (433 ±55 mL vs 626 ±76 mL; (1), vertigo (1),
for 2 weeks 40.8) p < 0.001) gas (1)
(unknown Second treatment: 214 mL
whether (390 ±73 mL vs 606 ±56 mL;
FT/PT) p < 0.01)
Kauppila 10 mg 3 times/day (n = 11) 4-20 weeks Nursing 285 ±75 mL to 530 ± Tired (4), tired plus None Randomized controlled
198541 for 3 weeks Placebo (n = 14) (unknown 162 mL/day (p < 0.01) headache (1), Conducted in Finland
whether Placebo: no change tired plus nausea
FT/PT) (1)
Lewis 10 mg 3 times/day (n = 10) 7-10 days Not noted Similar rates of breastfeeding None None Published as letter to the editor
198042 for 7 days Placebo (n = 10) (14 FT, 3 at 10 days, 6 weeks, and 3 Randomized controlled
PT per months postpartum All delivered via caesarean
group) section
De Gezelle 10 mg 3 times/day (n = 7) vs control 1 day Nursing every 50.7 ±14.6 g (day 3) to 84.3 None None Production estimated by weighing
198343 for 8 days (n = 6) (FT) 3 hours ±28.8 g (day 8) vs control: baby before and after second
41.7 ±24 g (day 3) to 41.7 ±daily feeding
25.6 g (day 8)
Day 3, NS
Day 8, p < 0.05
The Use of Galactogogues in the Breastfeeding Mother
The Annals of Pharmacotherapy n2012 October, Volume 46 n1399
Gupta 10 mg 3 times/day (n = 32) Unknown Nursing Complete lactation failure: 4 no None None Conducted in India
198544 for 10 days Complete lactation (FT/PT) response; 8 had response All infants managed in specialized
failure (12) (supplemental feedings de- care center for prematurity (6),
Partial lactation creased from 505.83 ±60.20 birth weight <2500 g (9), low
failure (20) mL to 223.75 ±64.75 mL at birth weight for gestational age
8 weeks) (3), neonatal infection (5),
Partial lactation failure: 13 hyperbilirubinemia (3), maternal
required supplementary feedings, pre-eclampsia (7) 4 nonrespond-
but decreased from 270.5 ±ers in complete lactation failure
36.87 mL to 153.07 ±38.85 group had complete failure of
mL at 8-week follow-up; 7 lactation for 30 days prior to
eliminated supplementary study entry
feedings within 5-11 days of
initiating metoclopramide
Hansen 10 mg 3 times/day (n = 28) vs placebo 3 days Electric breast Metoclopramide not associ- Facial rash and 1 death Randomized controlled
200545 for 10 days (n = 29) (PT) pump ated with significant increase itching (1) at day All received education from
in milk volume compared with 10, lactation nurse
placebo on each of 17 study not Women recorded length of time
days related pumping each time (results not
to provided)
study Preterm infants with gestational
drug age 23-34 weeks at delivery
Milk volume exact data not
presented (only represented in
Seema 10 mg 3 times/day (n = 25) vs control <4 months Nursing Not noted No significant difference Conducted in India
199746 for 10 days (n = 25) (unknown Relactation successful in 49 for 12-14 weeks of All received vitamin supplemen-
whether (98%) mothers follow-up tation and lactation education
FT/PT) 76% of mothers did not start
breastfeeding “soon after delivery”
86% baseline had complete
lactation failure; 14% were
partial failure
Infant weight exact data not
presented (only represented in
Birth weight estimated to nearest
5 g
Sakha 10 mg 3 times/day (n = 10) vs control Unknown Nursing Data not provided No difference between Randomized controlled
200847 for 15 days (n = 10) (FT) groups over 15 days Conducted in Iran
Metoclopramide 351.1 g All received training for breast-
vs control 328.5 g feeding
Fife 201148 10 mg 3 times/day (n = 13) vs placebo Within 6 Pumping every All increased significantly from Moderate to very None Randomized controlled
for 8 days (n = 13) hours (PT) 3 hours baseline severe reports 3 metoclopramide and 4 placebo
No differences between groups Fatigue (10), dropouts
nervous (3), Did not maintain power (10 pts.
constipation (2), per group)
depression (2), Preterm infants delivered 34
headache (1), weeks gestation
diarrhea (1) All pts. received lactation
No difference education
compared with Milk volume exact data not present-
placebo ed (only represented in graph)
ADRs = adverse drug reactions; FT = full-term delivery; PT = preterm delivery.
has been studied in 13 trials with mixed results; however,
the most recent, a randomized controlled trial with strong
trial design, failed to maintain power, which may have con-
tributed to the lack of significant differences found between
groups.48 Metoclopramide crosses into breast milk, but this
would result in subtherapeutic infant exposure because of a
low relative infant dose of 4.4%; the theoretical infant dose
is 18.75 µg/kg/day.49 One study estimated that the maxi-
mum exposure of the infant to metoclopramide would be
45 µg/kg/day, whereas typical pediatric dosing is 100-500
mg/kg/day for reflux.42,49 The only adverse event reported in
infants has been intestinal gas. Limitations of these studies
include small sample sizes, short duration, and indirect
measurement of milk production by weighing the infant be-
fore and after feeding, as well as not reporting maternal and
infant adverse events, infant weight gain, and adherence.
Additionally, no data were provided about several factors
known to influence milk supply, including length or fre-
quency of breastfeeding, caloric and fluid intake, and
stress/pain evaluation of the mother,nor was information
regarding adherence reported. Several studies were con-
ducted in different countries, making it difficult to evaluate
the influence of culture, diet, and other differences that
might exist. Overall, metoclopramide has been evaluated as
agalactogogue in 213 mothers, with mixed results. When
comparing various patient characteristics (preterm vs full-
term), time of initiation (within 14 days postpartum vs lat-
er), or trial characteristics (milk production measured by
weighing the infant vs pumping; randomized controlled tri-
als vs other designs), no subgroup strongly demonstrated
efficacy or overall efficacy.
Metoclopramide should not be used for all patients. The
labeling has a boxed warning for risk of tardive dyskinesia
when the drug is used for more than 3 months.50 Women
with a history of tardive dyskinesia or seizures or who are
at risk for developing tardive dyskinesia should avoid us-
ing this product. Metoclopramide may also increase the
risk for serotonin syndrome when used with other medica-
tions that act on serotonin. A few examples include selec-
tive serotonin receptor inhibitors, serotonin-norepinephrine
receptor inhibitors, monoamine oxidase agonist inhibitors,
and tramadol. Metoclopramide is renally eliminated and
requires dose reductions to 50% the normal dose when cre-
atinine clearance is less than 40 mL/min. Patients with
pheochromocytoma should also avoid metoclopramide be-
cause of the potential for hypertensive crisis. Despite the
AAP listing of metoclopramide as a drug with effects that
are unknown but that may be of concern, it received a lac-
tation category of L2 (safer: been studied in a limited num-
ber of breastfeeding women without an increase in adverse
events in the infant, and/or evidence of demonstrated risk
in infant is remote) in Medications in Mother’s Milk and is
considered medication with small risk in Drug Use in
Pregnancy and Lactation.49-51
Other Medications
Several other medications have been suggested as galacto-
gogues and/or have properties that may improve lactation.
First-generation antipsychotics and risperidone produce in-
creased prolactin levels and may increase milk supply. How-
ever, without a diagnostic indication for their use, we do not
recommend initiating therapy for breast milk production
alone because of potential maternal and infant adverse
Beer has been recommended for nursing mothers since
the 1800s. Beer is thought to increase milk production by in-
creasing prolactin levels.52,53 However, studies have shown
that breastfeeding infants consume 20% less milk 3- 4 hours
after the ingestion of beer by the mother, which was unrelated
to the number or duration of feedings but was likely sec-
ondary to decreased quantity produced.54,55 Additionally,
some of the alcohol consumed by the mother is transferred to
her milk and consumed by the infant. Alcohol consumption
has detrimental effects on the infant, including disruption in
sleep patterns and effects on gross motor development.55
Therefore, beer is no longer recommended as a galacto-
Although not touted as a galactogogue, depot-medrox-
yprogesterone (DMPA) has been shown to have favorable
effects on milk supply in women using the drug for contra-
ceptive purposes.56-58 It is speculated that galactogogue
properties may be secondary to an increase in prolactin
levels.58 Todate, no studies looking at DMPAgalacto-
gogue effects as a primary outcome have been completed.
Human growth hormone (GH) in doses ranging from 0.1
to 0.2 IU/kg/day (maximum of 16 IU/day) for 7 days has also
been used as a galactogogue because of its proposed ability to
increase prolactin levels.59,60 GH lacks FDA indication for use
as a galactagogue and has several limitations for use. First, it
is injected subcutaneously, which would require mothers to
prepare and inject it multiple times per day.Second, GH is
expensive. Also, the FDA is conducting an investigation on
the safety of GH use during childhood, with specific con-
cerns for increased mortality due to bone tumors and cardio-
vascular events in children exposed to GH.61 Considering
these factors, GH is not recommended for use as a galacto-
Thyroid-releasing hormone (TRH) has also been used
as a galactogogue. TRH is secreted in breast milk and, to
date, 3 of 4 studies have reported no benefit to using TRH
as a galactogogue. TRH dosing in these studies ranged
from 1 mg as a nasal spray 4 times daily for 10 days, 5 mg
twice daily for 5 days, 20 mg twice daily for 2 weeks, to 20
mg twice daily for 3 weeks. Each study reported an in-
crease in triiodothyronine and thyroxine; however,the
studies have not reported incidences of hyperthyroidism in
the mothers or infants.62-65 Unfortunately, the study periods
have not been long enough for the effects of elevations in
1400 nThe Annals of Pharmacotherapy n2012 October, Volume 46
AB Forinash et al.
triiodothyronine and thyroxine to be fully evaluated, and
there is a potential for mothers and infants to develop hy-
perthyroidism. Because of this risk and lack of evidence
overall of increased breast milk production, TRH is not
recommended for use as a galactogogue at this time.
Breast milk is considered to be the optimal food source for
newborns through 1 year of age. Although it is a natural food
source, women often encounter difficulties when attempting
to breastfeed and turn to supplemental sources of nutrition,
such as formula, for their infant prior to the infant’s first birth-
day. Although there are a variety of herbal and pharmaceuti-
cal options that have anecdotal evidence supporting their
ability to improve breast milk production, peer-reviewed
studies proving their efficacy and safety are lacking.
When approaching lactation difficulties, health care
providers should provide recommendations in a stepwise
fashion. Nonpharmacologic measures should first be used to
increase breast milk production. All mothers should receive
extensive education about proper breastfeeding techniques,
including latching, positioning, and length of feeding, since
these factors can significantly affect breastfeeding. Stress
contributes to decreased milk production by decreasing oxy-
tocin release.6,7,14 Because of this, relaxation techniques, deep
breathing, gentle massages, eating or drinking enjoyable
foods and beverages, and listening to music while breastfeed-
ing have been shown to initiate the milk ejection reflex as has
looking at things that remind her of the baby, such as a pic-
ture or blanket, while pumping.66 Other methods that encour-
age complete emptying of the breasts include massaging and
warming the breasts while pumping.67-69 Techniques to in-
crease milk supply include increasing feeding/pumping time,
decreasing intervals between feedings, increasing duration of
pumping, and increasing caloric and fluid intake. Some stud-
ies have shown that pumping both breasts simultaneously
may increase breast milk production as well as save the
mother time.66,70
If nonpharmacologic interventions fail to improve sup-
ply,the health care provider could consider recommending
metoclopramide or fenugreek; however, both medications
lack strong evidence to support efficacy. Metoclopramide and
fenugreek have some clinical evidence of their usefulness in
increasing breast milk production in lactating women and
they appear to be safe for the breastfeeding infant. Although
fenugreek is rated as GRAS, it is important for the health care
provider to remember that it has minimal safety data when
used as a galactogogue. As for safety, metoclopramide is con-
sidered by AAP to be a medication with unknown effects,
but its use may be of concern; however,other breastfeeding
sources have granted it category L2 status, medication with
small risk.49,51
Studies focused on breastfeeding are limited and often
lack the rigor and design that are expected in medical re-
search. Limitations of lactation studies often include small
sample sizes, short duration, and indirect measurement of
milk production by weighing the infant before and after
feeding. Additionally, trials commonly lack control for fac-
tors known to influence milk supply, including length or
frequency of breastfeeding, caloric and fluid intake, warm-
ing and massaging of breasts, and evaluation of maternal
levels of stress/pain. Currently, there are no available data
evaluating repeat courses or effects on lactation after medi-
cation discontinuation for any medication.
Although anecdotal evidence encourages the use of meto-
clopramide, fenugreek, asparagus, and milk thistle for their
galactogogue properties, efficacy and safety data in the litera-
ture are lacking. When examining the limited reported data
on potentially subtherapeutic exposure to the infant, it is like-
ly that metoclopramide and fenugreek can be used; however,
exposed infants should be monitored for any adverse events.
Oxytocin and domperidone are potentially available for com-
pounding purposes, but safety data are limited. Unfortunately,
at this time there is not enough efficacy and/or safety evi-
dence to support using other proposed galactogogues such as
milk thistle, goat’srue, beer,brewersyeast, alfalfa, aspara-
gus, domperidone, oxytocin, GH, TRH, or DMPA. Addition-
ally,potential risk for maternal and/or infant harm has not
been fully elucidated. More studies are needed to evaluate the
effects of available galactogogues on breast milk production.
Alicia B Forinash PharmD BCPS BCACP, Associate Professor of
Pharmacy Practice, Department of Pharmacy Practice, St. Louis
College of Pharmacy, St. Louis, MO
Abigail M Yancey PharmD BCPS, Associate Professor of Phar-
macy Practice, St. Louis College of Pharmacy
Kylie N Barnes PharmD BCPS, PGY-2 Ambulatory Care Phar-
macy Resident, St. Louis College of Pharmacy
Thomas D Myles MD, Professor, Obstetrics/Gynecology, Depart-
ment of Obstetrics, Gynecology,and Women’sHealth, School of
Medicine, St. Louis University
Correspondence: Dr. Forinash,
Reprints/Online Access:
Conflict of interest: Authors reported none
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Uso de Estimulantes de Producción de Leche Materna en Madres
que Amamantan
AB Forinash, AM Yancey, KN Barnes, y TD Myles
Ann Pharmacother 2012;46:1392- 404.
OBJETIVO: Revisar los datos existentes sobre la eficacia de productos
disponibles en los Estados Unidos y utilizados para estimular la
producción de leche materna.
FUENTE DE DATOS: Se realizó una búsqueda en PubMed (1966–junio
2012) y EMBASE (1973–junio 2012) utilizando los términos
amamantar, leche materna, lactancia, metoclopramida, oxitocina,
hormona de crecimiento, hormona estimulante de la tiroides,
medroxiprogesterona, domperidona, hierbas, galactogogue, fenugreek,
milk thistle, silymarin, goat’s rue, beer, asparagus racemosus, shatavari,
medicago sativa, alfalfa, onicus benedictus, blessed thistle, galega
officinalis, y brewer’s yeast.
estudios que incluyeran humanos, publicados en el idioma inglés y que
evaluaran la eficacia de productos utilizados para estimular la
producción de leche materna.
SÍNTESIS DE DATOS: Apesar que existe evidencia anecdótica que indica
que varias opciones farmacéuticas y productos herbarios causan un
aumento en la producción de leche materna, no existe suficiente
evidencia en la literatura que apoye su eficacia. Estudios con
metoclopramida, oxitocina, fenugreek, y milk thistle han tenido
resultados inconsistentes relacionados con la producción de leche
materna. Las muestras estudiadas son pequeñas y sus diseños tienen
varias limitaciones.
CONCLUSIONES: La leche materna es considerada la mejor fuente de
alimento para niños desde su infancia hasta el primer año de edad.
Varios factores influyen la producción de leche materna, incluyendo
presencia de dolor, enfermedades, tiempo disponible, ansiedad, y estrés
emocional. Se deben agotar las recomendaciones no farmacológicas
antes de añadir algún otro tratamiento. A pesar que existe evidencia
anecdótica que fomenta el uso de metoclopramida, fenugreek,
asparagus, y milk thistle para aumentar la producción de leche materna,
es necesaria evidencia científica que apoye su eficacia y seguridad. La
oxitocina y domperidona pudieran estar disponibles para la preparación
de mezclas extemporáneas potencialmente útiles, pero los datos sobre la
seguridad de su uso son limitados. Son necesarios estudios que evalúen
el efecto de los productos disponibles en la producción de leche materna.
Traducido por Astrid J García-Ortiz
L’Usage des Galactogogues chez la Mère qui Allaite
AB Forinash, AM Yancey, KN Barnes, et TD Myles
Ann Pharmacother 2012;46:1392- 404.
OBJECTIF: Revoir les données concernant l’efficacité des galactogogues
disponibles aux États-Unis et utilisés pour favoriser une production
accrue de lait maternel après l’accouchement.
SOURCES DE DONNÉES: Une revue de la documentation scientifique a été
effectuée par le biais de PubMed (1966 à Juin 2012) et EMBASE (1973
àJuin 2012). Les termes de recherche de langue anglaise incluaient:
breastfeeding, breast milk, lactation, galactogogue, metoclopramide,
oxytocin, fenugreek, milk thistle, silymarin, growth hormone, thyroid
releasing hormone, medroxyprogesterone, domperidone, goat’s rue,
beer, asparagus racemosus, shatavari, medicago sativa, alfalfa, onicus
benedictus, blessed thistle, galega officinalis, brewer’s yeast, et herbals.
langue anglaise incluant des sujets humains et des données évaluant
l’efficacité des galactogogues pour augmenter la production de lait
maternel ont été évaluées.
SYNTHÈSE DES DONNÉES: De l’information anecdotique est disponible
pour une variété d’options pharmaceutiques et botaniques concernant
leur utilité pour améliorer la production de lait maternel. Cependant la
documentation scientifique démontrant leur efficacité est insuffisante.
Les options tels que le métoclopramide, l’oxytocine, le fenugreek, et le
milk thistle ont démontré des résultats conflictuels en ce qui a trait à leur
capacité d’augmenter la production de lait maternel. Cependant, les
essais cliniques sont de faible envergure et présentent plusieurs limites.
CONCLUSIONS: Le lait maternel est considéré comme l’option nutritive
optimale pour les nouveaux nés jusqu’à l’âge de 1 an. Plusieurs facteurs
influencent la production de lait maternel incluant les douleurs
postpartum et subséquentes, la maladie, le temps disponible lors d’un
retour au travail, l’anxiété, et le stress émotionnel. Les options non
pharmacologiques doivent être épuisées avant d’ajouter une thérapie
médicamenteuse. Bien que des données anecdotiques encouragent
The Use of Galactogogues in the Breastfeeding Mother
The Annals of Pharmacotherapy n2012 October, Volume 46 n1403
l’utilisation de métoclopramide, de fenugreek, d’asparagus racemosus, et
de milk thistle pour leurs propriétés galactogogues, les données
concernant leur efficacité et leur innocuité sont insuffisantes dans la
documentation scientifique. L’oxytocine et le dompéridone sont des
traitements potentiellement disponibles pour des fins de préparations
magistrales mais les données d’innocuité sont limitées. Des études
additionnelles sont nécessaires afin d’évaluer les effets des
galactogogues présentement disponibles sur la production de lait
Traduit par Chantal Guévremont
1404 nThe Annals of Pharmacotherapy n2012 October, Volume 46
AB Forinash et al.
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... Popüler bir galaktagog olan bitkinin etki mekanizması tam bilinmemekle birlikte steroidal saponinlerin varlığı nedeniyle prolaktin seviyelerini artırarak etki ettiği düşünülmektedir (Zapantis, 2012;Forinash, 2012 (Demirezer, 2007). Yüzyıllar boyu birçok kültürde galaktagog amaçlı kullanılmıştır (Nice, 2002;Patel, 2013;Rosalle, 2015). ...
... Yüzyıllar boyu birçok kültürde galaktagog amaçlı kullanılmıştır (Nice, 2002;Patel, 2013;Rosalle, 2015). Anne ve bebeğin sindirimini düzenler (Patel, 2013 (Rosti, 1994 (Forinash, 2012). ...
... Pek çok bitkisel ajanda olduğu gibi, deve dikeninin de güvenlilik verileri azdır (Forinash, 2012). Genel olarak, güvenliliği ve galaktagog olarak etkinliği ayrıntılı olarak analiz edilmemiş olup daha ileri çalışmalara ihtiyaç duyulmaktadır (Dietz, 2016). ...
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Recently, usage of herbs and herbal products have gain popularity for several indications. The reason of the popularition of these products could be the thoughts of the people which natural products are much less harmful. with this point of view breastfeeding mothers are commonly using herbal products to raise their milk production (galactagogue) or treat post-natal diseases. But, there are big threats for both mother and baby in some issues such as the efficiency of herbal products, their toxicities, lack of scientific studies evaluating the effects on the baby, the large numbers of bioactive components and unavailability of convenient regulations. The aim of this review is to provide a guide about safety of popular herbal products commonly used by breastfeeding mothers and their effects on infants; to health care providers, such as pharmacists, who are the closest health advisors of patients, as well as physicians, and nurses and to ensure the careful use of herbal products in order to avoid undesirable effects by raising awareness that the word of "natural" is not synonymous with "safe". Laktasyon Döneminde Bitkisel Ürün Kullanımı ÖZ son yıllarda, çeşitli endikasyonlarda bitki ve bitkisel ürün kullanımı son derece popüler hale gelmiştir. Bunun nedeni muhtemelen, doğal olan her şeyin zararsız olduğu şeklindeki yaygın inanıştır. Bu düşünce ile emziren anneler de süt üretimini artırmak (galaktagog) veya doğum sonrası dönemde karşılaşılan rahatsızlıkları tedavi etmek amacıyla yaygın olarak bitkisel ürünleri kullanmaktadır. Ancak bitkisel ürünlerin etkinlikleri, toksisiteleri ve bebekler üzerindeki etkileri ile ilgili yeterli çalışma yapılmamış olması, içeriklerinde pek çok biyoaktif bileşen bulunması ve kontrollerinin yetersiz olması hem anne hem de bebek için tehdit oluşturmaktadır. Bu çalışmanın amacı, başta hastaların en yakın sağlık danışmanı olan eczacılar olmak üzere, hekimler, hemşireler gibi diğer sağlık hizmeti sunucularına emziren annelerde kullanımı yaygın olan popüler bitkisel ürünlerin güvenliliği ve bebekler üzerindeki etkileri hakkında bir rehber oluşturmak ve istenmeyen etkilerin önüne geçmek için, "doğal" kelimesinin "güvenli" ile eş anlamlı olmadığı konusunda farkındalıklarını artırarak bitkisel ürünlerin dikkatli kullanılmasını sağlamaktır.
... e composition of mother's milk is significantly affected by environmental variables and mother's nutrition [37]. However, many postpartum mothers have hypogalactia after motherhood due to mental stress, worry, and diseases [38]. us, mothers need breastfeeding support to increase their milk production. ...
... Metoclopramide is a popular galactagogue medicine that increases prolactin levels and enhances milk production [39]. However, there is a warning label on the medicine's box about late dyskinesia when the medication is used for more than three months [38]. ...
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Leucocalocybe mongolica is a known medicinal mushroom in China. It possesses many biological activities. This study investigated the effect of L. mongolica petroleum ether and water extracts (200, 500, and 1,000 mg/kg BW) on mammary gland differentiation during lactation. However, prolactin, growth hormone, progesterone, and estrogen levels were determined in serum by ELISA assay. Immunofluorescence, western blot, and real-time PCR were utilized to evaluate the expression levels of β-casein, α-Lactalbumin, prolactin receptor, progesterone receptor, and STAT-5a. The immunohistochemistry staining was used to detect the presence of steroid receptors. The results showed that petroleum ether and water extracts increased milk yield and milk content of calcium, total fat, total carbohydrate, and total protein. Prolactin and growth hormone levels were significantly upregulated in all treated groups compared with the control group. In contrast, progesterone and estrogen were downregulated. The high doses of petroleum ether and water extracts increased the expression levels of β-Cas, α-Lactalb, PRLR, PR, and STAT-5a. The observation of histological sections showed that the extracts induced higher mammary gland differentiation than the control group. This study is the first to use mushrooms as nutritional supplements to improve milk production and mammary gland differentiation during lactation.
... Furthermore, among the Macau women, the primary indications for use were in relation to modulating the amount of breastmilk produced and managing breast and nipple pain (Zheng et al., 2020). These findings indicate that variations in the types of HM used can be expected depending on women's cultural background and main indications for use (Forinash et al., 2012;Budzynska et al., 2013). ...
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Background: There are limited data on the use of herbal medicines (HM) among breastfeeding mothers, despite the fact that knowledge of the possible benefits or harms of HM use has a direct relationship with the health of infants, especially in resource-limited countries. The study aims to determine the prevalence and factors associated with HM use among breastfeeding mothers in Tanzania. Methods: The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from the reproductive and child health clinic at Uhuru health center in Morogoro, Tanzania. The survey instrument comprised of 34 questions, including demographic information, the pattern of HM use during breastfeeding, and women’s perceptions of HM. Chi-square test and logistic regression were used for data analysis using SPSS ver. 24.0. Results: The majority of the respondents (53.8%) used HM during breastfeeding. The most commonly used HM was black pepper (Piper nigrum L.; 80.0%), followed by pumpkin seeds (Cucurbita pepo L.; 18.0%). About one-third (27.5%) of HM users discussed their use with their healthcare providers. In addition, higher education levels and low breastmilk supply were identified as potential predictors of HM use. Conclusion: The practice of HM use among breastfeeding mothers in Tanzania is popular to ease breastfeeding difficulties. However, the issue of the safety or effectiveness of HM is still an unknown agenda. This awakens the need to evaluate HM’s safety, efficacy, and quality through pharmacological studies for scientific evidence. Lastly, a clinical guideline should be developed in healthcare settings to promote open dialogues between the healthcare providers and mothers to ensure the safe use of HM.
Metoclopramide (MCP) is a drug that has been widely used in recent years due to its hyperprolactinaemia effect on mothers during breastfeeding. The aim of this study was to investigate the proliferative changes that MCP may cause in the maternal breast tissue. In this study, 18 Wistar albino young–adult breastfeeding mothers with their offspring were divided into three groups: control group, low‐dose MCP‐applied group and high‐dose MCP‐applied group. The experiment was carried out during the lactation period and at the end of 21 days. Prolactin, BrdU and Ki‐67 breast tissue distributions were evaluated by immunohistochemistry, and tissue levels were evaluated biochemically by the ELISA method. According to ELISA and immunohistochemistry results in breast tissue, there was no significant difference between Ki‐67 and BrdU results in all groups. Metoclopramide did not change the expression of proliferation molecules Ki‐67 and BrdU in breast tissue. These results suggested that while metoclopramide increases breast proliferation, it does not have the risk of transforming the tissue into a tumour.
In this and all subsequent chapters, the outcomes assessed are limited to the offspring: the infant, toddler, older child, and adolescent. In Chap. 9, the focus is on feeding the infant and toddler. A large section of the chapter assesses differences in short- and long-term health in offspring who are breastfed vs those who are formula-fed. The effects of maternal nutrition, physical activity, and alcohol and drug use on breastfeeding are also reviewed. So too are the effects of different infant formulas, the baby’s need (or lack thereof) for other liquids, the age at introduction and types of solid foods, and vitamin and mineral supplements. Because the father often participates in feeding infants and toddlers, this chapter is the first to include the other key member of the parenting duo. Child health outcomes reviewed include infection, growth (in weight and length), obesity, brain development, behavior, allergic diseases, dental caries (cavities), and long-term conditions like high blood pressure, heart disease, diabetes, and cancer.
The World Health Assembly's target in exclusive breastfeeding has not been achieved. The most common factor contributing to this problem is the perceived insufficient production of breast milk, leading to the inability to give breastmilk to her child. Milk production can be increased using some ways, such as herbal galactagogue. This article aimed to review the effectiveness of some medicinal plants as galactagogues. This study uses a literature review approach by using several sources selected based on the criteria that have been set by researchers. Based on thirteen literature, herbs reviewed in this article showed positive effects as a galactagogue. Evidence regarding its efficacy and safety is scarce. Additionally, few clinical trials exist to justify its effectiveness. Further clinical trials are needed to support these findings.
Background Breast-feeding provides optimal nutrition along with immune support to newborns and infants and a host of lifelong health benefits to mother and child. Unfortunately, in daily health care practice, there are increasing numbers of reports on unsuccessful breastfeeding related problems. Galactagogues are substances that stimulate milk production. Hemocare®LACT, is a product of MMC Pharmaceuticals Ltd to enhance the milk secretion in lactating women. Objective To evaluate the safety and efficacy of Hemocare®LACT capsules on prolactin levels, infant body weight and hemoglobin in lactating mothers. Methods Open-label, placebo controlled, pilot, randomized controlled trial was conducted in a tertiary care hospital. A total of 72 eligible mothers were randomized to placebo or Hemocare®LACT in the ratio of 1:1. Serum prolactin, hemoglobin levels and infant weight were evaluated at baseline, 30th day, 60th day and in the 90th day post commencement of treatment. Results A significant difference in infant weight was found from baseline to 90th day in Hemocare®LACT group (p<0.01). Similarly, statistically significant difference was found in prolactin levels at 90th day when compared to baseline (p<0.05). Hemoglobin levels well maintained in Hemocare®LACT group. Conclusion Hemocare®LACT capsules increased prolactin levels and infants body weight in lactating mothers when compared to placebo with good tolerability.
Ethnopharmacological relevance: Evidence of phytochemical roles in infant development and maternal recovery offers insights into beneficial functions of traditional plant use during lactation and the postpartum period. Ethnopharmacological research has relevance to global priorities on maternal and child health, to understanding origins and determinants of human self-medication, and for reconciling traditional postpartum practices and mainstream healthcare. Aim of the study: Present emerging evidence, within evolutionary and socio-cultural contexts, on the role of maternal consumption on transfer of phytochemicals into breast milk with impacts on maternal and child health, and on infant development. Establish current state of knowledge and an ethnopharmacological research agenda that is attentive to cross-cultural and regional differences in postpartum plant use. Materials and methods: An extensive literature review using Medline, Scopus, and Web of Science focused on traditional and contemporary use and socio-cultural context, as well as physiological, pharmacological, toxicological, and behavioral activities of plants used medicinally by women during postpartum recovery and lactation. Results: The most widely reported postpartum plants show antimicrobial, anti-inflammatory, immunological, and neurophysiological activities, with low toxicity. Phytochemicals transfer from maternal consumption into breast milk in physiological concentrations, while animal studies demonstrate immunomodulation and other actions of medicinal plants during lactation. Reporting on the use and diverse traditional knowledge of women about plants during the postpartum period is obscured by the marginal place of obstetric issues and by gender biases in ethnobotanical research. In many contemporary contexts use is prejudiced by precautionary risk warnings in health literature and practice that confound lactation with pregnancy. Conclusions: Although systematic investigation of postpartum plant use is lacking, known pharmacological activities support potential benefits on infant development and maternal health with immediate and long-term consequences in relation to allergic, inflammatory, autoimmune, and other diseases. An ethnopharmacological agenda focused on the perinatal period requires directed methodologies and a regional approach in relation to culturally-specific knowledge and practices, traditional plant use, and local health needs. Testing the hypothesis that phytochemicals transferred from medicinal plants into breast milk impact the human immune system and other aspects of infant development requires extended analysis of phytochemicals in human milk and infant lumen and plasma, as well as effects on gastrointestinal and milk microbiome.
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Du fait de ses bénéfices pour la santé de la mère et de l’enfant, l’allaitement maternelexclusif est recommandé par l’Organisation Mondiale de la Santé jusqu’à l’âge de 6 mois.Cependant, la prévalence mondiale de l’allaitement reste relativement faible, notamment du faitd’arrêts précoces causés par la perception des mères de produire du lait en quantité insuffisantepour permettre une croissance optimale de leur bébé. Même si les déterminants de la productionde lait maternel sont multiples, la prise de suppléments nutritionnels aux propriétésgalactagogues, qui stimulent la lactation, pourrait aider les femmes ayant des difficultés àallaiter. Des extraits de plantes, comme le fenugrec, sont utilisés depuis des millénaires pourfavoriser la production de lait tandis que des acides aminés, comme l’arginine, ont été utiliséschez les animaux de rente pour augmenter les performances de lactation. Cependant, les preuves scientifiques de leur capacité galactagogue restent peu nombreuses et les mécanismes sont mal compris. Nous avons démontré, dans un modèle de rates allaitant des portées de grande taille, que le fenugrec et la L-arginine avaient la capacité de favoriser la croissance de la descendance par une augmentation de la production de lait et une modulation de sa composition. De plus, nous avons vérifié l’absence d’effets métaboliques délétères chez les mères et la descendance. Une étude de l’expression de gènes de la glandes mammaires et de l’hypophyse a permis d’avancer des pistes mécanistiques afin de jeter les bases physiologiques qui permettent d’envisager des essais cliniques futurs chez les femmes confrontées à des difficultés de lactation.
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Asparagus racemosus Willd. has repeatedly been mentioned as a galactogogue in Ayurvedic literature and has been confirmed through animal experiments as well. This randomized double-blind clinical trial evaluates its galactogogue effect in 60 lactating mothers by measurement of changes in their prolactin hormone level during the study. Several secondary parameters namely mothers' weight, babies' weight, subjective satisfaction of mothers and well-being and happiness of babies were studied to corroborate the primary findings. The oral administration of the research drug led to more than three-fold increase in the prolactin hormone level of the subjects in the research group as compared to the control group. The primary findings were corroborated by the secondary outcome measures and were found to be statistically significant (p < 0.05).
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Drug use during pregnancy and lactation is an almost inevitable event. Some of the drugs may have adverse effects on the baby on exposure. It is therefore necessary for the physician to be aware of the changes in pharmacokinetics and pharmacodynamics during pregnancy. Knowledge about the known teratogens and drugs safe to be used during pregnancy is essential on the part of the prescribing physician. There are many factors affecting drug passage into the milk and thus affecting the child in some cases. There are also some drugs affecting lactation. All this data needs to be carefully studied by the physician.
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The effect of using a warm breastshield on the efficiency, effectiveness, and comfort of expressing milk with an electric breast pump was assessed. The authors tested a standard breastshield at 25°C and a breastshield warmed to 39°C on 25 mothers using their maximum comfortable vacuum or -125 mm Hg. Using a warm breastshield effectively warmed the nipple and areola and, combined with maximum comfortable vacuum, decreased the time to remove 80% of the total milk yield and increased the percentage of available milk removed after 5 minutes of expression, with no change in the percentage of available milk removed after 15 minutes of expression compared with an ambient-temperature breastshield. The data confirmed that use of the mother's maximum comfortable vacuum was more efficient than a vacuum of -125 mm Hg. Using a warm breastshield with an electric breast pump was comfortable and improved the efficiency of milk removal.
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The aim of this study was to evaluate whether consumption of maternal herbal tea containing fenugreek had any effects on breast milk production and infants' weight gain pattern in the early postnatal period. Sixty-six (66) mother-infant pairs were randomly assigned to 3 groups. Group 1 (n = 22) consisted of mothers who were receiving herbal tea containing fenugreek every day. Group 2 (n = 22) and group 3 (n = 22) were assigned as placebo and controls, respectively. Birth weight, loss of birth weight, time of regain of birth weight, amount of breast milk assessed on the third day after delivery were determined. Maximum weight loss was significantly lower in infants in group 1 compared to both the placebo and control groups (p < 0.05). Infants in group 1 regained their birth weight earlier than those in control and placebo groups (p < 0.05). The mean measured breast milk volume of the mothers who received galactagogue tea was significantly higher than the placebo and control groups (p < 0.05). Maternal galactagogue herbal tea supplementation seems to be useful for enhancing breast milk production and facilitating infant birth weight regain in early postnatal days.
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Poor production of breast milk is the most frequent cause of breast lactation failure. Often, physician prescribe medications or other substances to solve this problem. The use of galactogogues should be limited to those situations in which reduced milk production from treatable causes has been excluded. One of the most frequent indication for the use of galactogogues is the diminution of milk production in mothers using indirect lactation, particularly in the case of preterm birth. The objective of this review is to analyze to the literature relating to the principal drugs used as galactogogues (metoclopramide, domperidone, chlorpromazine, sulpiride, oxytocin, growth hormone, thyrotrophin releasing hormone, medroxyprogesterone). Have been also analyzed galactogogues based on herbs and other natural substances (fenugreek, galega and milk thistle). We have evaluated their mechanism of action, transfer to maternal milk, effectiveness and potential side effects for mother and infant, suggested doses for galactogogic effect, and recommendation for breastfeeding.
Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short-and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Medical contraindications to breastfeeding are rare. Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive. Hospital routines to encourage and support the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed WHO/UNICEF "Ten Steps to Successful Breastfeeding." National strategies supported by the US Surgeon General's Call to Action, the Centers for Disease Control and Prevention, and The Joint Commission are involved to facilitate breastfeeding practices in US hospitals and communities. Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad. The "Business Case for Breastfeeding" details how mothers can maintain lactation in the workplace and the benefits to employers who facilitate this practice. Pediatrics 2012; 129:e827-e841
MC treatment has been shown to augment milk production and stimulate prolactin (PRL) secretion in women who develop defective lactation after a full-term normal delivery. We have studied the effect of oral MC treatment in 7 women who had delivered premature infants (BW 1127±191 gm, GA 29.0±1.5 wk, mean ± SE) and who were having difficulty maintaining lactation by regular milk expression with an electric and/or hand pump. Each woman had noted a gradual decrease in the total daily volume of expressed milk during the first several weeks of lactation. MC therapy (10 mg every 8 hrs for 7 days) was begun after increases in the number of expressions/day and dietary suggestions failed to increase milk production; it was initiated at 42±6 days post-partum (range 17-67 days). Daily milk volume increased in each patient between the first and seventh day of therapy; from 75±18 ml/day to 182±24 ml/day respectively (p<0.001). Serum PRL levels were measured by RIA in 4 of these women on 2 occasions. Basal PRL levels were 29±10 ng/ml (range 29 to 56 ng/ml) and were obtained prior to onset of MC therapy and prior to milk expression (laboratory normal for non-lactating women ≤20 ng/ml). After 5 to 7 days of MC, serum PRL levels were 123±35 ng/ml (range 70 to 225) 30 min after milk expression. These data demonstrate that the faltering milk production noted in some mothers of premature infants can be successfully treated with MC, and suggest that stimulation of PRL secretion by MC accounts for the significantly increased daily milk volume.
Breastfeeding rates in many developed countries remain low, and maternal perception of insufficient milk production is a major contributing factor. Mothers with a perception of insufficient milk should be advised that normal breastfeeding frequencies, suckling times, and amounts are very variable. If objective assessment confirms insufficient milk production, mothers should ensure optimal milk removal frequency and thorough breast drainage. In addition, galactogogues can be prescribed. Understanding physiological principles underlying milk production will help clinicians reassure and assist mothers.
The objective of this study was to investigate the efficacy of metoclopramide on augmentation of milk production in mothers of premature newborns. This was a randomized, double-blind, placebo-controlled trial. Women who delivered at ≤34 weeks of gestation, with no prior breastfeeding experience, singleton pregnancy, and no contraindications to using metoclopramide were eligible for entry. Twenty-five women were randomly assigned to receive 10 mg of metoclopramide or placebo three times daily for 8 days starting within 36 h of birth. Certified lactation nurses provided breastfeeding education. Breast milk expressed at each pumping session over the 8 days of treatment was recorded. Data from 18 patients were available for analysis. Milk production in both groups increased rapidly during the first 4 days and then more gradually to an average for the last 4 days of 633 ± 168 (9) ml/day [mean ± SEM (n)] for the placebo group and 459 ± 91 (10) ml/day for the metoclopramide group. Analysis with a repeated-measures ANOVA indicated a significant increase in milk production during the 8-day measurement period [within subjects p < 0.001]; however, there was no significant difference in milk production between the two groups [between subjects p = 0.427]. Side effects were similar between groups. In mothers with preterm babies, metoclopramide treatment does not augment (sample size had 80% power for detection of 50% difference) the breast milk production. Maternal interest, education, and support are recognized as mainstay in accomplishing successful lactation.