There are several prescription drugs that have been used to increase milk supply: Metoclopramide (Reglan), Domperidone (Motilium), and sulpiride (Eglonyl, Dolmatil, Sulpitil, Sulparex, Equemote).
The presence of an appropriate level of the hormone prolactin permits lactation to proceed normally. When a mother has low prolactin levels, milk supply may be affected. Prolactin levels are primarily regulated by inhibition: the presence of prolactin-inhibiting factors (dopamine is the principal one) keep prolactin levels in check. The drugs used for increasing milk supply work by blocking dopamine, which results in an increase in prolactin levels. These drugs do not work in all women and would not be expected to increase milk production in a woman who already has normal (high) prolactin levels.
Reglan has often been used in the U.S.. One major side-effect of Reglan is severe depression; it is contraindicated in moms with a history of depression, and all moms who take this should keep an eye out for signs of depression. One of my sources advises all adoptive mothers to stay away from Reglan, since it has caused serious depression/anxiety in moms regardless of previous history. This depression side effect usually develops over 3-4 weeks, and goes away if mom discontinues the Reglan. Other side effects include diarrhea, sedation, gastric upset, nausea, seizures and extrapyramidal effects (twitching, etc.)
Domperidone has been used successfully in Canada and other areas of the world, and has significantly fewer side effects than Reglan. It was approved by the American Academy of Pediatrics for use in breastfeeding mothers (this list is no longer maintained), and has been given Lactation Risk Category L1 (“safest”) in the 2012 edition of Medications and Mothers’ Milk. It is not available in the U.S. because the FDA issued a warning against it in 2004. See the links below for more info.
Sulpiride is commonly used in various countries including Zimbabwe, South Africa and Chile. The primary use for sulpiride is for schizophrenia (it is an antipsychotic and antidepressant), but it also increases serum prolactin levels and thus can enhance breast milk yield.
Prescription drugs that stimulate lactation
Name of medication
|Domperidone (Motilium, Motilidone)||
|Sulpiride (Dolmatil, Sulparex, Sulpitil, Eglonyl, Equemote)||
|** Per Medications and Mothers’ Milk by Thomas Hale, PhD (2012 edition)
† Hale reports results of a number of studies and indicates that domperidone is preferred but not available in the US. He notes that no pediatric concerns have been reported via milk, and that this drug is commonly used in pediatrics.
- Domperidone, Getting Started and Domperidone, Stopping by Jack Newman, MD, FRCPC
- Domperidone Effective But Unavailable (January 2010) by Amy Spangler
- Domperidone & the FDA
- FDA Warning on Domperidone (June 7, 2004)
- Judge rules for compounding pharmacists (May 28, 2006) from the Association of American Physicians and Surgeons. “In a landmark ruling, U.S. District Judge Rob Junell, in Midland, Texas, ruled that customized compounds created by compounding pharmacies are not new, unapproved drugs that must be sanctioned by the U.S. Food and Drug Administration.”
- Medical Center Pharmacy v. Mukasey (May 6, 2009) On July 18, 2008, the United States Court of Appeals for the Fifth Circuit issued a ruling in Medical Center Pharmacy v. Mukasey, No. 06-51583. The court rejected the finding by the United States District Court for the Western District of Texas that compounded drugs are exempt from the definitions of “new drugs” and “new animal drugs” in the Federal Food, Drug, and Cosmetic Act (FDCA).
- Domperidone Alert from BreastfeedingOnline.com
- On the FDA and Domperidone by Jack Newman, MD, FRCPC
- Is Domperidone Safe and Can it be Obtained Legally in the US? from LowMilkSupply.com
- Data sheet on domperidone [PDF] from MedSafe in New Zealand
- Campbell-Yeo ML. Effect of domperidone on the composition of preterm human breast milk. Pediatrics. 2010 Jan;125(1):e107-14.
- Wan EW, 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.
- Hansen WF, et al. Metoclopramide effect on breastfeeding the preterm infant: a randomized trial. Obstet Gynecol. 2005 Feb;105(2):383-9.
- da Silva OP, Knoppert DC. Domperidone for lactating women. CMAJ. 2004 Sep 28;171(7):725-6.
- Hale T. Medications and Mothers’ Milk, 14th edition. Amarillo, TX: Hale Publishing, 2010, p. 324-326.
- Henderson A. Domperidone. Discovering new choices for lactating mothers. AWHONN Lifelines. 2003 Feb-Mar;7(1):54-60.
- Gabay MP. Galactogogues: medications that induce lactation. J Hum Lact. 2002 Aug;18(3):274-9.
- Krouse AM. The family management of breastfeeding low birth weight infants. J Hum Lact. 2002 May;18(2):155-65.
- da Silva OP, Knoppert DC, Angelini MM, Forret PA. Effect of domperidone on milk production in mothers of premature newborns: a randomized, double-blind, placebo-controlled trial. CMAJ. 2001 Jan 9;164(1):17-21. (PDF version)
- Brown TE, Fernandes PA, Grant LJ, Hutsul JA, McCoshen JA. Effect of parity on pituitary prolactin response to metoclopramide and domperidone: implications for the enhancement of lactation. J Soc Gynecol Investig. 2000 Jan-Feb;7(1):65-9.
- Cheales-Siebenaler NJ. Induced lactation in an adoptive mother. J Hum Lact. 1999 Mar;15(1):41-3.
- Silvers D, et al. Domperidone in the management of symptoms of diabetic gastroparesis: efficacy, tolerability, and quality-of-life outcomes in a multicenter controlled trial. DOM-USA-5 Study Group. Clin Ther. 1998 May-Jun;20(3):438-53.
- Thompson NM. Relactation in a newborn intensive care setting. J Hum Lact. 1996 Sep;12(3):233-5.
- De Leo V, et al. Use of domperidone in the induction and maintenance of maternal breast feeding. Minerva Ginecol. 1986 Apr;38(4):311-5.
- Hofmeyr GJ, Van Iddekinge B, Blott JA. Domperidone: secretion in breast milk and effect on puerperal prolactin levels. Br J Obstet Gynaecol. 1985 Feb;92(2):141-4.
- Petraglia F, De Leo V, Sardelli S, Pieroni ML, D’Antona N, Genazzani AR. Domperidone in defective and insufficient lactation. Eur J Obstet Gynecol Reprod Biol. 1985 May;19(5):281-7.
- Cann PA, Read NW, Holdsworth CD. Galactorrhoea as side effect of domperidone. Br Med J (Clin Res Ed). 1983 Apr 30;286(6375):1395-6.
- Hofmeyr GJ, van Iddekinge B. Domperidone and lactation. Lancet. 1983 Mar 19;1(8325):647.
- Maddern GJ. Galactorrhoea due to domperidone. Med J Aust. 1983 Nov 26;2(11):539-40.
- Heykants J, Hendriks R, Meuldermans W, Michiels M, Scheygrond H, Reyntjens H. On the pharmacokinetics of domperidone in animals and man. IV. The pharmacokinetics of intravenous domperidone and its bioavailability in man following intramuscular, oral and rectal administration. Eur J Drug Metab Pharmacokinet 1981;6(1):61-70. Among other things, this study found that that absorption of domperidone increased from 13% to 23% if domperidone was given 90 minutes after eating.
- Fujino T, et al. Effects of domperidone on serum prolactin levels in human beings. Endocrinol Jpn. 1980 Aug;27(4):521-5.
“I just thought I would let you know about a very serious side effect related to the use of Reglan… I wanted to share my experience with the hope of warning any unsuspecting women of this possible nasty side effect.
“First, you should know that I am a lactation consultant, I recently gave birth to my fourth child and despite my training and knowledge, I was in need of a galactogogue. I opted for Reglan upon consultation with my physician and despite a history of mild depression.
“After taking the medication for approximately 6 weeks, I decided it was time to taper off of the medication. Within 48 hours of my last dose, I began to suffer from severe anxiety and eventually even had one panic attack. I have never had any problems with, or history of anxiety or panic attacks in my life and as the result of an in-depth assessment by an anxiety disorder specialist, it was determined that this development was directly related to my use of Reglan.
“This experience was absolutely horrible! I was bed ridden for 10 days and it took a total of three weeks for me to recover completely. Subsequently, my milk supply suffered substantially from the physical insult. I have since, however, been able to recover it partially only after arduous pumping and retraining of my baby to take the breast once again.
“As a lactation consultant, I will be happy to educate my clients on the use of this drug, but I will never again recommend it myself.”