Medication to increase milk supply

Is it OK to take medication to increase my milk supply?

Some mothers respond to medications used to increase milk supply, but others do not. One of these medications is domperidone, which is used to treat digestive problems. Governments have not approved it as a drug to increase milk supply, but its use for this purpose has been common for many years. Some studies have found it somewhat effective. Another drug called metoclopramide works in a similar way, increasing levels of the hormone prolactin, which helps mothers make milk. Studies on this drug show limited results. It too is not approved for this use. While both drugs can have significant side-effects, compared to domperidone, metoclopramide shows up in higher concentrations in breast milk, enters the brain in higher amounts, and appears less effective in increasing milk supply. 

A) Medications to increase milk supply

Some mothers have a low milk supply and wish to increase their milk supply. Herbs and medication can be used for this purpose (galactagogues). 

As drug regulators have not approved any galactagogues, using medication for this purpose is called an off-label use. 

Given the lack of data about the effectiveness of medication and their real risk of side-effects it is important that mothers:

  • Ensure their milk supply is truly low.
  • Consider other safer and possibly more effective tools for increasing their milk supply before starting medication.
  • Only start medication if it is safe and likely to increase their milk supply.
  • Only continue taking it if it clearly increases their milk supply.
  • Monitor their health and stop any medication if side-effects develop.

B) Domperidone

Domperidone is used to treat digestive problems: preventing nausea and vomiting and to help the bowel work.

One side-effect is an increase in levels of the hormone prolactin. Since prolactin is one of the hormones that help mothers make milk, a rise in prolactin levels may increase the amount of milk a mother makes. 

1) Popularity of domperidone

Domperidone was developed in the 1970s. The use of domperidone to increase milk supply has been steadily increasing (Mehrabadi 2018). One Canadian study (Smolina 2016) of breastfeeding women showed that in the Canadian province of British Columbia, one in three women with a premature birth and one in five women with a full-term birth were using domperidone in 2011.

This suggests either that a large group of women have significant breastfeeding challenges or more likely, that this medication is being used when not required. This is concerning as domperidone can cause side-effects, especially if taken in higher doses.

2) Effectiveness of domperidone

The quality of studies of domperidone is weak and they:

  • Include only small numbers of mothers.
  • Only follow mothers for a short time.
  • Are mostly of mothers who have delivered premature babies. 

Studies of mothers who were using domperidone and expressing for premature babies have reported that on average they were able to express 80 to 100 millilitres (about 3 U.S. fluid ounces) more milk (Donovan 2012; Grzeskowiak 2018; Taylor 2018; Wada 2019). Several other small studies have shown a bigger effect (Bazzano 2016).

The milk of mothers taking domperidone is not different from that of mothers not taking it (Campbell-Yeo 2010).

Although the evidence for domperidone’s efficacy is limited, we have found that some mothers respond to it. 

C) Metoclopramide

Metoclopramide is also used to increase milk supply. It has a similar method of action as domperidone and also increases prolactin levels. Its ability to increase milk supply is questionable (NIH; Shen 2021). As with domperidone, its use for increasing milk supply is unapproved. 

Metoclopramide has a long list of possible side-effects including depression. It may also cause permanent movement disorders and dangerous reactions and just as domperidone, can interact with other medications. 

One study of breastfeeding Australian mothers showed that, of those who were taking domperidone, 29% experienced side-effects (McBride 2021).

D) Comparing domperidone and metoclopramide

Domperidone and metoclopramide are closely related. They both work by blocking the action of the neurotransmitter, dopamine in the brain and nerves in the body. By blocking dopamine, they indirectly increase prolactin levels, a hormone which helps mothers make milk.

Domperidone is generally preferred to metoclopramide to increase milk supply as:

  • Metoclopramide shows up in higher concentrations in breast milk (1-11% of the mother’s dose) than domperidone (under 1% of mother’s dose) (Wan 2008).
  • Metoclopramide enters the brain much more easily than domperidone (Ferrier 2014; Gürgen 2020; Volpi 1984).
  • Metoclopramide appears to be less effective than domperidone in increasing milk supply (Asztalos 2018).
  • Long-term and severe side effects are more common when taking metoclopramide than when taking domperidone (Ingram 2012; Kanzaki 2019).

E) Metformin

Diabetic mothers have a higher chance of not having enough milk. Metformin is a medication that helps to control blood sugar levels. It can help mothers with polycystic ovarian syndrome to conceive.

There is very little evidence that metformin use increases milk supply (Nommsen-Rivers 2019).

F) Other medication

Other medication that can increase prolactin levels has been used to increase milk supply. Choices vary between countries.

Sulpiride is used as an anti-psychotic and anti-depressant medication. It can cause permanent disorders of movement, slurred speech, anxiety, and paranoia. It has questionable value in increasing milk supply. It enters the milk in large amounts and may pose a risk to the baby.

Chlorpromazine is an anti-psychotic medication. It has a range of possible serious and permanent side effects in mothers and has been reported to cause sleepiness in babies.

References

Asztalos EV. Supporting Mothers of Very Preterm Infants and Breast Milk Production: A Review of the Role of Galactogogues. Nutrients. 2018 May 12;10(5). pii: E600
 
Bazzano AN, Hofer R, Thibeau S, et al. A Review of Herbal and Pharmaceutical Galactagogues for Breast-Feeding. Ochsner J. 2016 Winter;16(4):511-524
 
Campbell-Yeo ML, Allen AC, Joseph KS, et al. Effect of domperidone on the composition of preterm human breast milk. Pediatrics. 2010 Jan;125(1):e107-14
 
Donovan TJ, Buchanan K. Medications for increasing milk supply in mothers expressing breastmilk for their preterm hospitalised infants. Cochrane Database Syst Rev. 2012 Mar 14;(3):CD005544
 
Ferrier J. Domperidone as an unintended antipsychotic. Can Pharm J (Ott). 2014 Mar;147(2):76-7

Gürgen SG, Yazıcı GN, Gözükara C, et al. Metoclopramide use to induce lactation can alter DRD2 and BDNF in the prefrontal cortex of offspring. J Chem Neuroanat. 2020 Nov;109:101844
 
Grzeskowiak LE, Smithers LG, Amir LH, et al. Domperidone for increasing breast milk volume in mothers expressing breast milk for their preterm infants: a systematic review and meta-analysis. BJOG. 2018 Feb 22
 
Ingram J, Taylor H, Churchill C, et al. Metoclopramide or domperidone for increasing maternal breast milk output: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2012 Jul;97(4):F241-5

Kanzaki A, Tada H, Otsuka A, et al. Severe tardive dyskinesia induced by domperidone in presenile and non-dementia type 2 diabetes man with alcohol misuse showing albuminocytological dissociation and white matter hyperintensity. BMJ Case Rep. 2019 May 29;12(5):e228789

McBride GM, Stevenson R, Zizzo G, et al. Use and experiences of galactagogues while breastfeeding among Australian women. PLoS One. 2021 Jul 1;16(7):e0254049

Mehrabadi A, Reynier P, Platt RW, et al. Domperidone for insufficient lactation in England 2002-2015: A drug utilization study with interrupted time series analysis. Pharmacoepidemiol Drug Saf. 2018 Aug 14
 
Nommsen-Rivers L, Thompson A, Riddle S, et al. Feasibility and Acceptability of Metformin to Augment Low Milk Supply: A Pilot Randomized Controlled Trial. J Hum Lact. 2019 May;35(2):261-271

Shen Q, Khan KS, Du MC, et al. Efficacy and Safety of Domperidone and Metoclopramide in Breastfeeding: A Systematic Review and Meta-Analysis. Breastfeed Med. 2021 Mar 25

Smolina K, Morgan SG, Hanley GE, et al. Postpartum domperidone use in British Columbia: a retrospective cohort study. CMAJ Open. 2016 Jan 12;4(1):E13-9
 
Taylor A, Logan G, Twells L, et al. Human Milk Expression After Domperidone Treatment in Postpartum Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Hum Lact. 2018 Nov 27:890334418812069
 
United States National Institute of Health (NIH), National Library of Medicine, Toxnet, Drugs and Lactation Database (Lactmed) [Internet]. Bethesda: U.S. National Library of Medicine; [date unknown] [cited 2019 Oct 10]
 
Volpi R, Coiro V, Castelli A, et al. Different effects of metoclopramide and domperidone on GH release in type I male diabetics. Horm Metab Res. 1984 Dec;16 Suppl 1:131-3
 
Wada Y, Suyama F, Sasaki A, et al. Effects of Domperidone in Increasing Milk Production in Mothers with Insufficient Lactation for Infants in the Neonatal Intensive Care Unit. Breastfeed Med. 2019 Sep 4
 
Wan EW, Davey K, Page-Sharp M, et al. Dose-effect study of domperidone as a galactagogue in preterm mothers with insufficient milk supply, and its transfer into milk. Br J Clin Pharmacol. 2008 Aug;66(2):283-9