Medication

Did medications decrease my milk supply?

Some medications may reduce milk supply, including hormonal birth control, stimulants used for weight loss and attention deficit, and over-the-counter cold medications containing decongestants and antihistamines. It is possible that some antidepressants and some antipsychotics reduce milk supply. Research on pills containing dried, ground human placenta is limited, but in theory they could reduce milk supply.

A) Managing medications that reduce milk supply

A small number of medications can reduce a mother's milk supply. This may happen within a day of starting medication or it may develop over a number of weeks. 

If their milk supply does decrease, mothers should take steps to increase their milk supply and ensure that their baby continues to take in enough milk and supplement with milk if necessary. They should also have a discussion with their health-care providers and consider: 

  • Stopping the offending medication.
  • Using an alternative medication.
  • Using a lower dose of the current medication.

For more information, mothers can refer to the Lactmed (NIH) website.

B) Hormonal birth control

In our clinic, hormonal birth control is the most common medication reported by mothers to cause a reduced milk supply.

The majority of mothers in our clinic were able to return to a full milk supply. Some required the use of domperidone.

C) Placental encapsulation

Placental encapsulation is the practice of drying and grinding the placenta and packaging it in pills that are taken by the mother.

Research on these pills is limited. Placental hormones can remain biologically active during encapsulation and in theory could reduce milk production (Young 2016). This effect may be similar to that of a retained placental fragment, which continues to secrete progesterone after the birth of the baby, preventing the milk from coming in.

D) Antidepressant medication

Mothers who use certain types of medication (selective serotonin reuptake inhibitors [SSRIs]) for depression may have their milk come in late (Marshall 2010). There is also limited evidence that use of these medications may result in a low milk supply (Hernandez 2011). However, such mothers are also more likely to struggle with breastfeeding for other reasons.

E) Other medication

Other medications that can decrease milk supply include (Anderson 2017):

  • Hormones: testosterone
  • Medications that increase dopamine: methylergonovine  
  • Stimulants used for:
    • Weight loss
    • Attention deficit disorders
  • Over-the-counter medications:
    • Decongestants: pseudoephedrine (Aljazaf 2003)
    • Antihistamines: diphenhydramine, chlorpheniramine
  • Antipsychotics: aripiprazole (Cuomo 2018), promethazine
  • High-dose steroids that are injected
  • Medication to stop lactation: bromocriptine, cabergoline, lisuridefurosemide
  • Nicotine from patches, gum, cigarettes
  • Certain stimulant street drugs

Some of these medications can have other harmful effects on the baby.

Sage and parsley have been used to decrease a large milk supply, but there is no research to support this. They are relatively safe for mothers and babies.

References

Aljazaf K, Hale T. Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol. 2003 Jul; 56(1): 18–24
 
Anderson PO. Drugs that Suppress Lactation, Part 2. Breastfeed Med. 2017 May; 12:199-201
 
Cuomo A, Goracci A, Fagiolini A. Aripiprazole use during pregnancy, peripartum and lactation. A systematic literature search and review to inform clinical practice. J Affect Disord. 2018 Mar 1;228:229-237
 
Marshall AM, Nommsen-Rivers LA, Hernandez LL, et al. Serotonin transport and metabolism in the mammary gland modulates secretory activation and involution. J Clin Endocrinol Metab. 2010 Feb;95(2):837-46
 
Hernandez LL, Collier JL, Vomachka AJ, et al. Suppression of lactation and acceleration of involution in the bovine mammary gland by a selective serotonin reuptake inhibitor. J Endocrinol. 2011 Apr;209(1):45-54
 
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 2018 Oct 10]
 
Young SM, Gryder LK, Zava D, et al. Presence and concentration of 17 hormones in human placenta processed for encapsulation and consumption. Placenta. 2016 Jul;43:86-9