Concerned over Side Effects of Medications used to Increase Lactation?

Concerns over potential side effects of medications used to initiate or increase lactation are very understandable. It is essential to be healthy and well for yourself and to provide the best care for your baby. Considering using medications to support milk production requires balancing any risks versus benefits. This blog post focuses on any risks to you as the lactating parent, with some brief mentions of the benefits for milk production.

(Why? Because your IBCLC would not suggest a medication unless she expected a significant benefit based on her experience and training, and the published literature. And, yes, you should be working with an IBCLC if you are not producing enough milk to meet your baby's needs. Rarely does taking a medication alone resolve milk production issues.)

These are some major categories of medications that you may consider:

• Hormonal medications: Hormonal medications involving estrogen and/or progesterone are primarily used for inducing lactation to initiate lactation and not commonly used for other reasons milk production may be lacking. Your IBCLC will suggest suitable hormonal medications and your prescribing provider and pharmacist will supervise their use, including informing you of potential side effects. 

• Metoclopramide (Reglan®): Your prescribing provider and pharmacist may also supervise the use of Reglan. While Reglan has been found to significantly increase milk production when used appropriately, it may have serious side effects on the central nervous system, such as depression and dystonia (involuntary body movements).¹ Dystonia may not resolve upon discontinuation of Reglan. Because risks of these side effects increase with the length of use, use of Reglan is not recommended for longer than two or three weeks. Two or three weeks may not be enough time for Reglan to adequately support milk production in certain scenarios, including inducing lactation. 

• Domperidone: Domperidone can significantly increase milk production when used appropriately.^2,3,4,5,6 Although this medication is safe for nearly all lactating parents, it is currently not approved by the US FDA.^4,7,8,9,10 As a result, most parents in the US will not use it under the supervision of their prescribing provider and pharmacist. This is why I created DomHub, a in-depth research-based online resource for all things domperidone suitable for both parents and professionals. DomHub contains a listing of contraindications for domperidone use and a comprehensive section on potential side-effects of domperidone, including how to mitigate many of those side effects. I compiled this list of potential side effects from 2 research studies in which a total of nearly 900 lactating parents who took domperidone were surveyed — talk about crowd-sourcing!^11,12

 “Reglan made me feel like I was jumping out of my skin.  It was horrible!  I switched to domperidone, had no difficulties, and my milk production increased dramatically.” – Lisa B.

Stay tuned for a future blog post on risks to the human milk fed infant when their lactating parent takes a medication. Spoiler alert: only a small percentage of any medication is released into the milk, making most medications taken by lactating parents generally safe for babies. Certainly any medication suggested by your IBCLC to promote milk production has been found to be safe for human milk fed babies unless specifically contraindicated.

If you have any questions or need guidance on inducing lactation, relactation or co-lactation, feel free to schedule a free mini consultation with me HERE. Or if you are ready to jump right in, check out my consultation packages HERE. I work with parents in person or via telehealth from wherever you are.

References

¹Nice, F. J. (2016). Domperidone.  Retrieved from https://nicebreastfeeding.com/counseling-tips/

²Shen, Q., Khan, K. S., Du, M. C., Du, W. W., & Ouyang, Y. Q. (2021). Efficacy and safety of domperidone and metoclopramide in breastfeeding: A systematic review and meta-analysis. Breastfeeding Medicine, 16(7), 516-529. https://doi.org/10.1089/bfm.2020.0360

³Taylor, A., Logan, G., Twells, L., & Newhook, L. A. (2019). Human milk expression after domperidone treatment in postpartum women: a systematic review and meta-analysis of randomized controlled trials. Journal of Human Lactation, 35(3), 501-509. https://doi.org/10.1177/0890334418812069

⁴Asztalos, E. V., Campbell-Yeo, M., da Silva, O. P., Ito, S., Kiss, A., Knoppert, D., & EMPOWER Study Collaborative Group. (2017). Enhancing human milk production with domperidone in mothers of preterm infants: results from the EMPOWER trial. Journal of Human Lactation, 33(1), 181-187. https://doi.org/10.1177/0890334416680176

⁵Grzeskowiak, L. E., Lim, S. W., Thomas, A. E., Ritchie, U., & Gordon, A. L. (2013). Audit of domperidone use as a galactogogue at an Australian tertiary teaching hospital. Journal of Human Lactation, 29(1), 32-37. https://doi.org/10.1177/0890334412459804

⁶da Silva, O. P., Knoppert, D. C., Angelini, M. M., & Forret, P. A. (2001). Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial. Cmaj, 164(1), 17-21.

⁷Moriello, C., Paterson, J. M., Reynier, P., Dahl, M., Aibibula, W., Fisher, A., ... & Filion, K. B. (2021). Off-label postpartum use of domperidone in Canada: a multidatabase cohort study. Canadian Medical Association Open Access Journal, 9(2), E500-E509. https://doi.org/10.1111/bcp.14737

⁸Mehrabadi, A., Reynier, P., Platt, R. W., & Filion, K. B. (2018). Domperidone for insufficient lactation in England 2002‐2015: A drug utilization study with interrupted time series analysis. Pharmacoepidemiology and Drug Safety, 27(12), 1316-1324. https://doi.org/10.1002/pds.4621

⁹Grzeskowiak, L., & Smithers, L. (2017). Use of domperidone and risk of ventricular arrhythmia in the postpartum period: Getting to the heart of the matter. Pharmacoepidemiology and Drug Safety, 26(7), 863-864. https://doi.org/10.1111/1471-0528.15177

 ¹⁰Boyce, M. J., Baisley, K. J., & Warrington, S. J. (2012). Pharmacokinetic interaction between domperidone and ketoconazole leads to QT prolongation in healthy volunteers: a randomized, placebo‐controlled, double‐blind, crossover study. British journal of clinical pharmacology, 73(3), 411-421.  https://doi.org/10.1111/j.1365-2125.2011.04093.x

¹¹Hale, T. W., Kendall-Tackett, K., & Cong, Z. (2018). Domperidone versus metoclopramide: Self-reported side effects in a large sample of breastfeeding mothers who used these medications to increase milk production. Clinical Lactation, 9(1), 10-17. https://connect.springerpub.com/content/sgrcl/9/1/10.abstract

¹²McBride, G. M., Stevenson, R., Zizzo, G., Rumbold, A. R., Amir, L. H., Keir, A. K., & Grzeskowiak, L. E. (2021). Use and experiences of galactagogues while breastfeeding among Australian women. PloS one, 16(7), e0254049. https://doi.org/10.1371/journal.pone.0254049