Drugs to stimulate or suppress breastmilk supply Flashcards
What is a galactogogue?
a drug that stimulates, promotes or induces lactation
When may a galactogue be indicated?
- to increase supply (particularly where milk supply is impacted by illness or prematurity)
- to induce lactation in adoptive or surrogate mothers
What herbal preparations are thought to increase milk supply?
- limited evidence of effectiveness
- fenugreek
- milk thistle
- shatavari
- asparagus
- hops
- fennel seed
- alfalfa
What is the trade name for domperidone?
Motilium
What is the mode of action for galactogogues domperidone and metoclopramide?
- dopamine antagonist
- antiemetic
- blocks prolactin inhibiting hormone - increases prolactin levels and subsequently milk supply in some women
What is the usual indication for domperidone?
- increase milk supply by increasing prolactin levels where other methods have been ineffective
- used with other strategies like regular feeding and/or pumping
What is the usual stock strength and dose when using domperidone to stimulate milk supply?
- 10mg/tablet PO TDS for two to four weeks, taper dose
- only 25 tablets available on PBS, preferable to prescribe 100 tablets
What adverse effects are associated with domperidone?
- dry mouth
- headache
- rash
- insomnia
rarely: - dizziness
- palpitations
- restlessness
- swelling of feet
What contraindications/precautions are associated with domperidone?
- contraindicated if cardiac conduction issues, severe electrolyte disturbances or underlying cardiac disease
- interacts with some other drugs (including erythromycin, flucanozole)
What are common causes of low milk supply?
- rare to actually have low milk supply, mostly perceived-
- insufficient removal of milk from breasts
- poor attachment
- infrequent feeding
- sleepy infant
- mother-infant separation
- unresolved engorgement
- use of formula, teats, dummies
- tongue tie and lip tie
- insufficient glandular tissue due to hypoplastic breasts or breast reduction surgery
- maternal medical problems - retained products, PPH, anaemia, diabetes, obesity, medications, hypothyroidism, PCOS, hormone imbalance, inverted nipples, sheehan’s syndrome (necrosis of pituitary gland, complication of severe PPH)
- use of combined oral contraceptive pill
- excessive exercise
- infant medical problems (congenital abnormalities, cardiac problems, prematurity)
- menstruation or subsequent pregnancy
- early introduction of solids
What are the signs/symptoms of low milk supply?
- fewer than 3 wet nappies/day by day 3, 5-6/day after day 5
- concentrated urine
- no change or less than normal poos
- weight loss greater than 10% of birth weight
- not regaining birth weight by 2 weeks
- prolonged or continual feeding with little evidence of satiety
- persistant jaundice
- sleepy/lethargic infant
- excessive crying
- unwell infant
- no signs of lactogenesis II on day 3-4 (breast fullness/heaviness)
- breasts remain soft between feeds (normal after 3 weeks)
Apart from domperidone, what is another drug with galactogogue effects?
- metoclopramide (Maxolon or Pramin) is also a dopamine antagonist
- generally used to treat nausea/vomiting
- rarely prescribed now to increase milk supply, but may be used for women who cannot take domperidone due to allergic reaction or prolonged QT interval
What are the adverse effects of metoclopramide?
- restlessness
- drowsiness
- fatigue
- insomnia
- dizziness
- depression/anxiety
- extrapyramidal effects
What drugs may be used to suppress lactation?
- bromocriptine
- cabergoline
What is the trade name of cabergoline?
- Dostinex
- Dostan
