Pharmaceutical Galactagogues

Two main prescription medications are used to increase milk production: Metoclopramide (Reglan) and Domperidone. Both function similarly by acting on dopamine receptors to inhibit dopamine production, which stimulates prolactin release. Higher prolactin levels promote lactation.

Domperidone

Domperidone maleate (commonly called "dom") treats slowed stomach emptying and inflammation while promoting lactation as a side effect. Some physicians will prescribe it to help increase breast milk in new mothers that are struggling with low milk supply.

The medication is part of the Newman-Goldfarb Induced Lactation Protocols, used alongside herbal galactagogues. Standard dosing is 20-40 mg four times daily. Domperidone tablets typically contain 10 mg.

Availability varies by location. In the US, it requires a prescription from compounding pharmacies only, while many European countries sell it over-the-counter.

Common brand names include: Motilium, Vesperidone, Vomistop, Vomilux, Motilium-V, and GI Norm.

Is Domperidone Safe?

You may have heard concerns about domperidone and cardiac risk. The studies behind these warnings were conducted on elderly patients (average age 72–79) who had pre-existing heart conditions such as high blood pressure and coronary artery disease. The dose-related cardiac warning for doses above 30mg/day was based on data from only four patients.

A peer-reviewed article in the Canadian Family Physician concluded that "individuals younger than age 60 years and women did not have increased risk from domperidone exposure" and that "the risks reported in these papers would not directly apply to healthy women of childbearing age." A separate meta-analysis demonstrated a statistically significant increase of 74.7% in daily milk production with domperidone, with no maternal safety issues when compared to placebo.

As with any medication, consult your doctor before taking domperidone — particularly if you have an underlying cardiac condition or are taking other medications that may interact with it.

Sources: Canadian Family Physician — Health Canada advisory on domperidone, NIH LactMed — Domperidone

Metoclopramide (Reglan)

Reglan was previously common in the US but has declined in use due to serious side effects. Major side effects include depression/anxiety, which comes on after a period of 3-4 weeks and will subside after the medication is discontinued.

Additional adverse effects include nausea, seizures, and twitching.

For more information, see Domperidone for Lactation.