Galactagogue

Synthetic galactagogues such as domperidone and metoclopramide interact with the dopamine system in such a way to increase the production of prolactin; specifically, by blocking the D₂ receptor.{{cite journal |vauthors=Forinash AB, Yancey AM, Barnes KN, Myles TD |title=The use of galactogogues in the breastfeeding mother |journal=Ann Pharmacother |volume=46 |issue=10 |pages=1392–404 |year=2012 |pmid=23012383 |doi=10.1345/aph.1R167 |s2cid=207264697 }}

There is some evidence to suggest that mothers who are unable to meet their infants' breastfeeding needs may benefit from galactogogues.{{cite journal |vauthors=McInnes RJ, Chambers J |title=Infants admitted to neonatal units—interventions to improve breastfeeding outcomes: a systematic review 1990-2007 |journal=Matern Child Nutr |volume=4 |issue=4 |pages=235–63 |year=2008 |pmid=18811790 |doi=10.1111/j.1740-8709.2008.00150.x |pmc=6860595 }}{{cite journal |vauthors=Osadchy A, Moretti ME, Koren G |title=Effect of domperidone on insufficient lactation in puerperal women: a systematic review and meta-analysis of randomized controlled trials |journal=Obstet Gynecol Int |volume=2012 |pages=642893 |year=2012 |pmid=22461793 |pmc=3306907 |doi=10.1155/2012/642893 |doi-access=free }}

A more recent study questions the effectiveness of commercial lactation cookies finding no significant difference.

{{cite journal |vauthors=Palacios AM, Cardel MI, Parker E, Dickinson S, Houin VR, Young B, Allison DB |title=Effectiveness of lactation cookies on human milk production rates: a randomized controlled trial |journal=The American Journal of Clinical Nutrition |volume=117 |issue=5 |pages=1035–1042 |date=May 2023 |pmid= 36921902|doi=10.1016/j.ajcnut.2023.03.010 |pmc= |doi-access=free }}

Galactagogues may be considered when non-pharmacologic interventions are found to be insufficient.{{cite journal |vauthors=Forinash AB, Yancey AM, Barnes KN, Myles TD |title=The use of galactogogues in the breastfeeding mother |journal=Ann Pharmacother |volume=46 |issue=10 |pages=1392–404 |date=October 2012 |pmid=23012383 |doi=10.1345/aph.1R167 |s2cid=207264697 }} For example, domperidone may be an option for mothers of preterm babies who at over 14 days from delivery and after full lactation support still have difficulty expressing breast milk in sufficient quantity for their child's needs.{{cite journal |vauthors=Donovan TJ, Buchanan K |title=Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants |journal=Cochrane Database Syst Rev |volume=3 |pages=CD005544 |year=2012 |issue=3 |pmid=22419310 |doi=10.1002/14651858.CD005544.pub2 |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0040836/|pmc=11747959 }} Lactation induction may also be possible in certain circumstances for women planning to adopt an infant.{{cite book |last1=Murkoff |first1=Heidi |last2=Murkoff |first2=Sharon |title=What To Expect: The First Year |date=2014 |publisher=Workman Publishing |isbn=978-0-7611-8150-7 |pages=94–95 |edition=3rd}}

Domperidone (like metoclopramide, a D₂ receptor antagonist) is not approved for enhanced lactation in the USA.{{Cite journal | vauthors = Da Silva OP, Knoppert DC | title = Domperidone for lactating women | doi = 10.1503/cmaj.1041054 | journal = Canadian Medical Association Journal | volume = 171 | issue = 7 | pages = 725–726 | year = 2004 | pmid = 15451832 | pmc =517853 }}{{Cite journal | last1 = The Academy Of Breastfeeding Medici | doi = 10.1089/bfm.2011.9998 | title = ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting the Rate of Maternal Milk Secretion (First Revision January 2011) | journal = Breastfeeding Medicine | volume = 6 | issue = 1 | pages = 41–49 | year = 2011 | pmid = 21332371}} By contrast, Australian guidelines consider domperidone to be the preferred galactagogue when non-pharmacological approaches have proved insufficient.{{cite journal |vauthors=Amir LH, Pirotta MV, Raval M |title=Breastfeeding—evidence based guidelines for the use of medicines |journal=Aust Fam Physician |volume=40 |issue=9 |pages=684–90 |year=2011 |pmid=21894275 |url=http://www.racgp.org.au/afp/201109/43841 |access-date=2013-08-18 |archive-date=2018-05-27 |archive-url=https://web.archive.org/web/20180527201749/https://www.racgp.org.au/afp/201109/43841 |url-status=dead }} Unlike metoclopramide, domperidone does not cross the blood–brain barrier and does not tend to have adverse effects such as drowsiness or depression.

Other drugs which may increase lactation include:

• Antipsychotics such as risperidone, chlorpromazine and sulpiride, due to their ability to block the D₂ receptor{{cite journal |last=Zuppa |first=Antonio |first2=Paola |last2=Sindico |first3=Claudia |last3=Orchi |first4=Chiara |last4=Carducci |first5=Valentina |last5=Cardiello |first6=Costantino |last6=Romagnoli |first7=Piero |last7=Catenazzi |title=Safety and Efficacy of Galactogogues: Substances that Induce, Maintain and Increase Breast Milk Production|journal=Journal of Pharmacy & Pharmaceutical Sciences|year=2010|volume=13|issue=2|pages=162–174|url=https://ejournals.library.ualberta.ca/index.php/JPPS/article/view/6663 |doi=10.18433/j3ds3r|pmid=20816003 |doi-access=free}}
• Certain hormones such as oxytocin, growth hormone (GH), and thyrotropin-releasing hormone (TRH).

Progestogens like progesterone, medroxyprogesterone acetate, and cyproterone acetate have been found to produce lobuloalveolar development of the breasts, which is important for lactation as milk is produced in the mammary lobules.{{cite journal | vauthors = Conneely OM, Mulac-Jericevic B, Arnett-Mansfield R | title = Progesterone signaling in mammary gland development | journal = Ernst Schering Found Symp Proc | series = Ernst Schering Foundation Symposium Proceedings | volume = 2007 | issue = 1 | pages = 45–54 | date = 2007 | pmid = 18543434 | doi = 10.1007/2789_2008_075 | isbn = 978-3-540-73492-5 }}{{cite journal | vauthors = Penagos Tabares F, Bedoya Jaramillo JV, Ruiz-Cortés ZT | title = Pharmacological overview of galactogogues | journal = Vet Med Int | volume = 2014 | issue = | pages = 602894 | date = 2014 | pmid = 25254141 | pmc = 4165197 | doi = 10.1155/2014/602894 | doi-access = free }}{{cite journal | vauthors = Kanhai RC, Hage JJ, van Diest PJ, Bloemena E, Mulder JW | title = Short-term and long-term histologic effects of castration and estrogen treatment on breast tissue of 14 male-to-female transsexuals in comparison with two chemically castrated men | journal = Am J Surg Pathol | volume = 24 | issue = 1 | pages = 74–80 | date = January 2000 | pmid = 10632490 | doi = 10.1097/00000478-200001000-00009 | doi-access = free }}

Herbals and foods used as galactagogues have little or no scientific evidence of efficacy, and the identity and purity of herbals are concerns because of inadequate testing requirements.{{cite journal |vauthors=Mortel M, Mehta SD |title=Systematic review of the efficacy of herbal galactogogues |journal=J Hum Lact |volume=29 |issue=2 |pages=154–62 |date=May 2013 |pmid=23468043 |doi=10.1177/0890334413477243 |s2cid=38727190 |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0057268/}}

The herbals most commonly cited as galactagogues are:

• Shatavari (Asparagus racemosus)
• Fenugreek (Trigonella foenumgraecum){{Cite web |first1=Caroline J. |last1=Chantry |first2=Cynthia R |last2=Howard |first3=Anne |last3=Montgomery |first4=Nancy |last4=Wight |title=Use of galactogogues in initiating or augmenting maternal milk supply |series=ABM protocols, Protocol#9 |year=2004 |website=The Academy Of Breastfeeding Medicine |url=http://www.bfmed.org/ace-files/protocol/prot9galactogoguesEnglish.pdf |archive-url=https://web.archive.org/web/20070628052457/http://www.bfmed.org/ace-files/protocol/prot9galactogoguesEnglish.pdf |archive-date=28 June 2007 |url-status=dead }}
• Torbangun (Coleus amboinicus), which has been used by the Batak people of Indonesia as a galactogogue for hundreds of years.{{cite journal |vauthors=Damanik R, Wahlqvist ML, Wattanapenpaiboon N |title=Lactagogue effects of Torbangun, a Bataknese traditional cuisine |journal=Asia Pac J Clin Nutr |volume=15 |issue=2 |pages=267–74 |year=2006 |pmid=16672214 }}
• Fennel (Foeniculum vulgare)
• Milk thistle (Silybum marianum); in 2010 the European Food Safety Authority considered and rejected a claim for silybum as a galactagogue because the evidence was deemed insufficient.{{citation needed|date=May 2017}}
• Chasteberry (Vitex agnus-castus)
• Goat's rue (Galega officinalis)

Other herbals that have been claimed to be galactagogues include:

• Blessed thistle{{Cite web|url=http://canadianbreastfeedingfoundation.org/induced/herbs.shtml|title = Herbs for Increasing Milk Supply |publisher=Canadian Breastfeeding Foundation . Fondation canadienne de l'allaitement |author1=Jack Newman |author2=Edith Kernerman |date=2009 |access-date=2023-12-13}}
• Alfalfa{{cite journal|vauthors=Nice FJ |title=Common Herbs and Foods Used as Galactogogues |journal=ICAN: Infant, Child, & Adolescent Nutrition|date=19 May 2011|volume=3|issue=3|pages=129–132 |doi=10.1177/1941406411406118}}
• Anise
• Nettle
• Oatmeal
• Vervain
• Red raspberry leaf
• Marshmallow (althaea) root
• Moringa{{Cite web |url=https://www.drugs.com/breastfeeding/moringa.html |title=Moringa use while Breastfeeding |date=May 4, 2023 |website=Drugs.com |access-date=2023-12-13}}

• Galactorrhea
• Herbalism
• Hypothalamic–pituitary–prolactin axis

{{Reflist}}

{{Galactagogues|state=expanded}}

{{Prolactin receptor modulators}}

Category:Biologically based therapies

Category:Breastfeeding

Category:Galactagogues

Category:Systemic hormonal preparations