Appropriate use of galactagogues: a guide for nurse practitioners in primary care

The short term and long-term benefits to mother and baby with breastfeeding are well documented. However, the actual rates of exclusive breastfeeding to 6 months of age are less than 17% in Canada. The most often cited reason for discontinuation of breastfeeding is not enough breast milk, which has increased the use of galactagogues--substances used to induce or augment lactation in breastfeeding women. There is a lack of guidance regarding the appropriate use of galactagogues because at present there is only one clinical practice guideline from the American Academy of Breastfeeding Medicine (ABM) which does not describe actual use in practice and has not been updated since 2004. This has resulted in practice based on anecdotal evidence, with a wide variation in indications, dosages, and duration of treatment among primary care practitioners. A literature review of galactagogue use and research from 2000 to 2010 was performed, grey literature such as presentations, theses and dissertations were included, and practitioners were interviewed regarding their own use of galactagogues in practice. In Canada, the most widely used galactagogues are the herb fenugreek, and the medication domperidone. Fenugreek has not had any randomized controlled trials (RCT) to support its safety or efficacy in practice, which makes its recommendation more difficult, particularly because it has been reported to have significant side effects such as hypoglycemia. Conversely, domperidone has been shown to be safe and effective, with low incidence of side effects. Domperidone is used widely in Canadian practice for this off-label purpose by physicians and nurse practitioners (NP). When accompanied by assessment and treatment of underlying physiological causes of breast milk insufficiency and or milk transfer issues such as poor infant latch, domperidone 10 mg three times daily with thorough assessment and follow up is a reasonable and safe galactagogue choice. --P. 2.