Galactagogues and Breastfeeding

Galactagogues (sometime spelled as galactogogues) are medications and herbs used to boost breast milk supply. Many of these substances work by increasing levels of prolactin, which is one of the main hormones involved in breast milk production. Each year, approximately 15% of breastfeeding mothers in the U.S. take at least one galactagogue to increase milk supply for their newborn.

Galactagogues should not be used to increase one’s breast milk supply until after other lactation-boosting methods have been tried (such as frequent milk removal from breastfeeding/pumping, correcting a painful or insufficient latch, massaging the breasts, increasing skin-to-skin time, using relaxation techniques to reduce stress/promote milk flow, and/or contacting a lactation consultant or IBCLC for breastfeeding support). It’s also important to make sure there is not a medical cause of a nursing mother’s low milk supply. This can include but is not limited to a thyroid gland imbalance, retained placental fragments, postpartum hemorrhage, smoking, alcohol use, diabetes, or mammary gland insufficiency.

The two most common galactagogue prescription medications for lactating women are Metoclopramide (Reglan) and Domperidone. Both work by increasing prolactin levels but can have serious adverse effects, and can only be used under clinical protocol and by the guidance of a physician.

Metoclopramide (Reglan):

• Suggested Dose: 10mg by Mouth 3-4 Times Daily

• Suggested Length of Treatment: 7-14 Days

• Side Effects: Drowsiness, anxiety, depression, and restlessness. Need to avoid using if a new mother has risk factors of postpartum depression (PPD), a history of PPD, or current symptoms of depression. Risk of a very serious neurological problem called Tardive Dyskinesia has led the FDA to put a black box warning on the use of Metoclopramide.

Domperidone:

• Suggested Dose: 10-20mg by Mouth 3 Times Daily

• Suggested Length of Treatment: 7-28 Days

• Side Effects: Dry mouth, abdominal pain, and cramping. Should not be used in women with a heart rhythm problem called “Prolonged QTc Syndrome.” It is dangerous to give Domperidone at the same time as some other medications, including Fluconazole (Diflucan), certain antibiotics, grapefruit juice, and marijuana/CBD. Side effects on the breastfed infant are unknown. The FDA recommends against the use of Domperidone to increase milk production and it is not currently available in the U.S.

Herbs have been used throughout history and around the world to increase breastmilk production in mother’s supplies and induce lactation, too. Although herbal medicines are available over the counter (OTC), much like prescription ones, they can still have serious side effects and drug interactions. Widely used herbal galactagogues, that have been shown to be effective in increasing breast milk supply in research studies, include fenugreek, milk thistle, ginger, goat’s rue, moringa, and torbangun (Coleus). A deeper dive into each herbal supplement can be found below:

Fenugreek: A commonly used spice that works by Increasing sweat production. Phytoestrogen hormones found in fenugreek increase milk flow.

• Suggested Dose: 600mg by Mouth 3-4 Times Daily

• Suggested Length of Treatment: 1-3 Weeks

• Side Effects:

  • Diarrhea (Most Common)

  • Body Odor (Maple Syrup Smell)

  • Cross-Reactivity with Asteraceae/Compositae Family (Ragweed), Peanuts & Fabaceae Family (Chickpeas, Soybeans, and Green Peas)

  • Asthma, Bleeding, Dizziness, Flatulence (Gas), Hypoglycemia (Low Blood Sugar), Loss of Consciousness, Skin Rash, Wheezing

  • Contraindicated During Pregnancy - Causes Uterine Contractions & Can Lead to Preterm Labor

• Drug Interactions:

  • Hypoglycemics (Including Insulin)

  • Antiplatelet Drugs (Aspirin, Heparin, Warfarin)

  • Feverfew

  • Primrose Oil

Milk Thistle: The herbal name is known as Silymarin and it’s also called ”St. Mary’s Milk.” Milk Thistle increases prolactin levels and has weak anti-estrogenic properties.

• Suggested Dose: 420mg of Micronized Silymarin by Mouth Once Daily

• Suggested Length of Treatment: Unknown (Duration in Studies Ranges from 28-63 Days)

• Side Effects:

  • Mild Gastrointestinal Side Effects

  • Dry Mouth

  • Nausea

  • Weight Gain

  • Cross-Reactivity with Asteraceae/Compositae Family (Ragweed)

• Drug Interactions:

  • Lowers Blood Levels of Phenytoin & Warfarin

  • Possible Increased Clearance of Estrogens

  • Possible Increased Levels of Statins (Anti-Cholesterol Drugs)

Ginger: A popular galactagogue in Thailand and is used as a flavoring agent and condiment worldwide. Has anti-emetic (prevents nausea), antioxidant, and anti-inflammatory properties. Ginger works by increasing blood supply to lactating breasts.

• Suggested Dose: 500mg by Mouth Twice Daily

• Suggested Length of Treatment: For at least one week after giving birth.

• Side Effects:

  • Bad Taste

  • Heartburn

  • Abdominal Discomfort

  • Weight Gain

  • Dry Mouth

  • Headaches

• Drug Interactions:

  • Morphine (Leads to Elevated Levels & Risk of Respiratory Depression)

  • Aspirin (Increased Risk of Bleeding)

Goat’s Rue: Also known as ”French Lilac” and has been used as a natural treatment for diabetes. Its mechanism of action is unknown.

• Suggested Dose: 15ml of 5% Goat’s Rue Tincture by Mouth 3 Times Daily

• Suggested Length of Treatment: Unknown

• Side Effects:

  • Hypoglycemia (Low Blood Sugar)

  • Diarrhea

  • Hepatomegaly (Liver Enlargement)

  • Headaches

  • Jitteriness

  • Weakness

  • Increased Risk of Bleeding & Bruising (Inhibits Platelet Aggregation)

• Drug Interactions:

  • Hypoglycemic Medications for Diabetes (Insulin & Sulfonylureas)

  • Antiplatelet & Anticoagulant Medications, Including Warfarin

Moringa: This is a widely used galactagogue in the Philippines, where it is called ”Malunggay.” The leaves contain vitamins, minerals, essential amino acids, and glycosides. Moringa works by inducing production of the prolactin hormone by the pituitary gland.

• Suggested Dose: 250-350mg by Mouth 3 Times Daily

• Suggested Length of Treatment: Unknown (Probably At Least One Month Based on Research Findings)

• Side Effects:

  • Hepatotoxicity (Liver Damage)

  • Kidney Failure

  • Hepatorenal Syndrome

• Drug Interactions: None Known

Torbangun (Coleus): From the mint family and has been used as a galactagogue for centuries by the Bataknese people of Indonesia. It works by increasing production of secretory mammary cells.

• Suggested Dose: 150g by Mouth Daily

• Suggested Length of Treatment: Unknown (Duration in Only Study With Human Lactation Was for 28 Days)

• Side Effects:

  • Increased Risk of Bleeding

  • Hypotension (Low Blood Pressure)

• Drug Interactions:

  • Calcium Channel Blockers

  • Anticoagulant/Antiplatelet Medications

  • Nitrates

  • Lowers Blood Levels of Phenytoin & Warfarin

Other herbal galactagogues include fennel seed, dandelion, marshmallow, shatavari, seaweed, anise, basil, oats, millet, chamomile, alfalfa, tumeric, brewer’s yeast, garlic, and blessed thistle.

There are various all-natural lactation teas on the market for those who are concerned if they’re producing enough milk. These teas contain combinations of bitter fennel, anise, coriander, fenugreek, blessed thistle, lemongrass, lemon verbena, and marshmallow root. However, there are no scientific research studies on how effective these teas are in terms of increasing milk volume. The only published study on any of these teas is regarding the safety of a brand of tea called ”Mother’s Milk.” Breastfeeding women who consumed this tea were found to have no difference in adverse symptoms (in mom or baby), maternal mental health, and infant growth outcomes compared to mothers who drank a placebo tea.

Milk-supply boosting products are also widely available in both capsule and tincture form at pharmacies, vitamin shops, baby supply stores, and online in the U.S. The most common ingredients in these products include fenugreek, blessed thistle, nettle, and fennel. Like the lactation teas mentioned above, there is no published data as to whether these products have any true intervention on breast milk supply.

In summary, use of galactagogues should only be made after other efforts to increase milk supply have been tried, medical causes of low milk supply have been ruled out, and a careful inquiry into potential side effects & drug interactions have been made. Like with all medications and supplements, the risks versus benefit of starting a galactagogue should be carefully weighed in consultation with one’s health care provider. Galactagogues should not be taken with a “one size fits all approach” and one that might be a good fit for you might not be a safe option for another mother due to its side effects or drug-on-drug interactions.

Resources:

• Academy of Breastfeeding Medicine: https://www.bfmed.org/
• Hales Medications and Mother‘s Milk: www.halesmeds.com
• InfantRisk Center at Texas Tech University: www.infantrisk.com
• LactMed Drugs and Lactation Database: https://www.ncbi.nlm.nih.gov/books/NBK501922/