Erica,
You are diving into a topic that does not have nearly as much research
as is needed! Since no one else has posted, I will try to address some
of your questions. One thing important to remember in all of these
discussions is, "what is the cause of the low milk supply?" When we talk
about the efficacy of various reputed galactogogues, it is not fair to
judge them without regard to the circumstances of a mother. When the
situation is a simple management issue, galactogogues tend to work very
well. In mechanical issues (ie breast surgery), poor glandular
development or hormonal imbalances, a galactogogue may or may not be
effective. While we usually know how medicinal galactogogues work (such
as increase prolactin), we know almost nothing about what aspect of
lactation each herbal galactogogue may effect. When you read or hear
various reports, do keep this in mind.
Use of domperidone for milk supply: First of all, domperidone has never
been approved for any use by the FDA in the U.S., and probably never
will be. Back in 1999 I wrote to the FDA about it and received a generic
response about off-label uses and confidentiality issues. I have been
told that since we already have other drugs on our market that meet the
same label-need as domperidone, that it will never be put through the
expensive approval process. The second problem is very simple:
manufacturers rarely do straight-forward research on drugs for use on
pregnant/lactating women specifically, probably because of liability
risks. Most all of what we learn comes from observations of side-effects
of medications. There are so many drugs that have "off-label" uses which
are never formalized......... Domperidone and metoclopramide both fall
into that category.
Thyrotropin-releasing hormone (TRH): increases the release of prolactin,
but long-term use could induce hyperthyroidism. As you note, it is not
generally used in clinical practice.
Growth Hormone (GH): Stimulates IGF-1 and IGF-2 with benefits to milk
production. However, it is very expensive and therefore not terribly
feasible.
Fenugreek: This is an herbal galactogogue, which brings up a whole
different world of issues in general. While there have been research
studies done with major popular herbs, lactation has for the most part
not been much of a concern. There are many reputed herbal galactogogues,
but very little research. Cheryl Refree has done a study of herbal
galactogogue use among LCs; her study can be found on the website
http://www.healthyconnections.ws/, along with her hospital's protocol
for fenugreek usage. Nancy Hurst RN IBCLC in Houston has been conducting
a study on fenugreek among her mothers of premature infants. One of the
biggest obstacles she has run into is that it is hard to come up with a
placebo if the mom is aware that fenugreek usually causes sweat and
urine to smell like maple syrup. You could contact her for the latest
information on her work.
I'm out of time for the moment; I hope this helps. I also am listowner
for a breastfeeding and herbs discussion group, should you be
interested. There are several herbal experts in the group. Subscribe:
[log in to unmask]
~Lisa Marasco MA IBCLC
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