From the Guidelines
The drug of choice for lactation stimulation is domperidone, typically prescribed at 10-20 mg three to four times daily. This recommendation is based on the evidence that domperidone, when taken orally, has low levels in milk due to first-pass hepatic and intestinal metabolism, making it a safe option for lactating women 1. Additionally, domperidone is used as a galactagogue, which may increase milk supply, and it is essential to ensure the woman has access to a breast pump if there is any delay in feeding her infant.
Some key points to consider when using domperidone for lactation stimulation include:
- Treatment usually continues for 1-2 weeks, with gradual tapering once milk production is established
- Combining medication with frequent breast emptying through nursing or pumping every 2-3 hours, adequate hydration, and proper nutrition is crucial for optimal results
- Non-pharmacological options, such as improving latch technique, increasing nursing frequency, and using herbal supplements like fenugreek, can be tried first, although evidence for herbs is limited
- Patients should be monitored for side effects, such as headache, abdominal cramping, or dry mouth
It's worth noting that metoclopramide is an alternative option, also used as a galactagogue, which may increase milk supply, but it has more central nervous system side effects compared to domperidone 1. Therefore, domperidone is the preferred choice due to its safer side effect profile and effectiveness in increasing milk production.
From the FDA Drug Label
Orally administer 0.5 mg/lb (1.1 mg/kg) once daily starting 10 to 15 days prior to Expected Foaling Date (EFD). Treatment may be continued for up to 5 days after foaling if mares are not producing adequate milk after foaling. The drug of choice for lactation stimulation is domperidone.
- The recommended dosage is 0.5 mg/lb (1.1 mg/kg) once daily.
- Treatment should start 10 to 15 days prior to Expected Foaling Date (EFD) and may be continued for up to 5 days after foaling if necessary 2.
From the Research
Drug of Choice for Lactation Stimulation
- The effectiveness of metoclopramide for enhancing milk production in lactating women has been studied in several trials 3, 4, 5, 6, 7.
- A study published in the Lancet in 1981 found that metoclopramide significantly increased breast-milk secretion in puerperal women with inadequate production of breast-milk 3.
- Another study published in the Journal of the Society for Gynecologic Investigation in 2000 found that metoclopramide and domperidone both caused a significant increase in prolactin secretion, but the response was most influenced by parity 4.
- However, a systematic review and meta-analysis published in the Korean Journal of Family Medicine in 2021 found that metoclopramide did not increase the milk volume of the intervention groups compared to that of the control groups 5.
- A study published in the Journal of Clinical Endocrinology and Metabolism in 1981 found that metoclopramide increased prolactin release and milk secretion in puerperium without stimulating the secretion of thyrotropin and thyroid hormones 6.
- A randomized trial published in the Journal of Maternal-Fetal & Neonatal Medicine in 2011 found that metoclopramide treatment did not augment breast milk production in mothers with preterm babies 7.
Key Findings
- Metoclopramide may be useful for improving poor lactation, but its effectiveness may depend on various factors such as parity and individual response 3, 4.
- The medication therapy of choice for enhancing lactation may not be the same in all women, but may instead be determined by parity 4.
- Metoclopramide did not improve milk production in lactating women, and its use is not recommended for this purpose 5.
- Maternal interest, education, and support are recognized as mainstay in accomplishing successful lactation 7.