- A health professional should always be involved in the decision to use a galactagogue.
- Drugs to manage inadequate lactation should only be used where there is objective evidence to support diagnosis and where non-drug methods have failed.
- There are no drugs licensed in the UK to improve lactation.
- As long as the possible cardiac effects are taken into account, domperidone is considered to be the agent of choice for inadequate lactation because of its superior side effect profile, efficacy, and minimal passage into breast milk.
- Domperidone should not be used for inadequate lactation where the mother or infant has a cardiac disorder or are receiving treatment with drugs known to affect the QT interval e.g. ketoconazole or erythromycin, in which case metoclopramide is preferred.
- A maternal daily dose of 30mg domperidone should not be exceeded. The maximum treatment duration should not usually exceed one week.
- Further studies are needed to determine the optimum regimen and duration of treatment.
- There are insufficient data to support the use of herbal remedies.
Acting Co-Director, West Midlands Medicines Information Service & UK Drugs in Lactation Advisory Service