What medication can be prescribed to increase lactation in a postpartum (post-partum) patient?

From the Guidelines

Domperidone is the most effective medication to increase lactation in a patient who recently delivered, and it should be prescribed at 10-20 mg three to four times daily for 1-2 weeks, then tapered as milk production improves. This is based on the fact that domperidone is used as a galactagogue, and when taken orally, levels in milk are low due to first-pass hepatic and intestinal metabolism 1. Metoclopramide is also an option, and it may be used in lactating women as it is also used as a galactagogue, so may increase milk supply 1.

Some key points to consider when prescribing these medications include:

• Ensuring the patient has optimized non-pharmacological approaches like frequent breastfeeding, proper latch technique, and adequate hydration and nutrition
• Monitoring for side effects - domperidone may cause dry mouth and headache, while metoclopramide can cause fatigue and, rarely, extrapyramidal symptoms with prolonged use
• Considering herbal alternatives like fenugreek (2-3 capsules three times daily) may also help, though evidence is less robust
• Ensuring the woman has access to a breast pump if there is any delay in feeding her infant when using domperidone 1

It is essential to note that medication should be considered a supplement to good breastfeeding practices rather than a replacement. Other medications like neostigmine, sugammadex, granisetron, cyclizine, prochlorperazine, and dexamethasone are not typically used to increase lactation and may not be suitable for use during breastfeeding due to limited data on their transfer into human milk or potential adverse effects 1.

From the FDA Drug Label

EFFECTIVENESS A randomized, masked, controlled, laboratory effectiveness study evaluated the effectiveness of 1. 1 mg/kg EQUIDONE Gel administered once daily beginning 10 to 15 days prior to the expected foaling date (EFD - defined as 340 days after the median breeding) and continuing up to 5 days after foaling for the prevention of fescue toxicosis Table 3 Gestation Length, Milk Production and Mammary Gland Development Treatment Group(number mares)Mean gestation length in daysPercent adequate milk production at foalingPercent adequate mammary gland development at foaling EQUIDONE Gel (13)337100% (13 / 13)100% (13 / 13)

The medication that can be prescribed to increase lactation in a patient who recently delivered is domperidone (PO), as it has been shown to increase milk production in mares. However, it is essential to note that the provided study is related to mares, not humans, and the use of domperidone for lactation in humans may not be directly applicable.

• Key points:
  • Domperidone has been shown to increase milk production in mares.
  • The study was conducted on mares, not humans.
  • The use of domperidone for lactation in humans may require further evaluation 2.

From the Research

Medications for Increasing Lactation

• Domperidone is a medication that can be prescribed to increase lactation in patients who have recently delivered, as it has been shown to increase prolactin levels and milk production 3, 4, 5, 6.
• Metoclopramide is another medication that can be used to increase milk production, but it has been associated with more side effects compared to domperidone 6, 7.
• The choice of medication may depend on various factors, including parity, as nulliparous women may respond differently to metoclopramide and domperidone compared to multiparous women 7.

Comparison of Domperidone and Metoclopramide

• Both domperidone and metoclopramide have been shown to increase breast milk output in mothers with infants in neonatal intensive care 6.
• Domperidone may be a safer option compared to metoclopramide, as it does not cross the blood-brain barrier and has been associated with fewer side effects 4, 6.
• However, domperidone is not approved by the US Food and Drug Administration due to concerns about its safety, and its use is currently off-label 3.

Safety and Efficacy

• The safety and efficacy of domperidone for increasing lactation have been studied in several clinical trials, and it has been shown to be effective in increasing milk production with minimal side effects 4, 5, 6.
• However, more research is needed to fully understand the risks and benefits of using domperidone for lactation, particularly in the long term 3, 5.