Got milk, but not enough? You’re not alone. As the number of breastfeeding mothers has increased, so too has the incidence of insufficient milk and along with it an increase in the use of galactagogues—substances that reportedly increase milk production. But do they work?

In an effort to determine the effectiveness of various galactagogues, Philip Anderson and Veronica Valdes conducted a review of the published literature on the most widely used galactagogues. The results of their review can be found in the December 2007 issue of Breastfeeding Medicine.

The authors found that the majority of the studies on galactagogues do not meet current evidence-based standards such as randomization, placebo control, and blinding. In addition, many of the studies were conducted before there was knowledge of appropriate breastfeeding management—mothers and babies were separated, babies were placed on strict feeding schedules, and mothers were given no encouragement or support.

“Of the four well-designed studies that did provide maternal lactation education, three found that galactagogues made no difference in lactation success,” said the authors. The fourth enrolled such a small number of patients and had such a high dropout rate that the results could not be interpreted.

Several well-performed studies included “all comers” and failed to discern the need for a galactagogue, subsequently diluting any possible differences between drug and placebo groups.

An added criticism was lack of data on the adverse effects of the drugs when used as galactagogues—despite reports of elevated serum prolactin in breastfed infants of mothers taking metoclopramide and concerns about maternal depression with metoclopramide and sulpiride (domperidone).

One well-designed study of sulpiride (domperidone) measured serum prolactin levels in relation to tablet ingestion rather than breastfeeding, making it impossible to determine whether the reported prolactin values represented baseline prolactin, stimulated prolactin, or some value in between. The authors found that the daily number of breastfeeds were low by today’s standards. Because most of the infants in the placebo and experimental groups were supplemented, it was impossible to tell if the added weight gain in the sulpiride group was caused by increased milk production or supplementation.

A summary of the review follows:

• No direct correlation was found between baseline serum prolactin and long-term breastfeeding success.
• Routine use of galactagogues in unselected patients from population subgroups that reportedly have difficulty breastfeeding, such as mothers who have had a cesarean birth or those who have given birth prematurely, appears to be of no benefit.
• When mothers are given appropriate education and support, galactagogues have little or no benefit.
• The safety of dopamine antagonists when used as galactagogues has not been established.
• Large, well-designed studies are needed before the effectiveness and safety of galactagogues can be established.

Fortunately, most breastfeeding problems can be prevented and resolved with proper management. In the end, there is no substitute for effective position and latch, frequent and untimed feedings, and good knowledge and support. So if you’re searching for a “magic bullet” to solve breastfeeding problems, perhaps it’s time to acknowledge that the magic bullet has been there all along—a breast and a baby!