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Saejueng K, Nopsopon T, Wuttikonsammakit P, Khumbun W, Pongpirul K. Efficacy of Wang Nam Yen herbal tea on human milk production: A randomized controlled trial. PLoS One 2022; 17:e0247637. [PMID: 35100251 PMCID: PMC8803155 DOI: 10.1371/journal.pone.0247637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Insufficient milk production is a common problem affecting breastfeeding women, in particular following Cesarean delivery. Wang Nam Yen herbal tea is a promising traditional Thai medicine used by postpartum women to stimulate milk production, as an alternative to pharmaceutical galactagogues. We aimed to compare the efficacy of Wang Nam Yen herbal tea, domperidone, and placebo, in increasing milk production in mothers who underwent Cesarean delivery. Methods Women who underwent uncomplicated cesarean delivery at Sunpasitthiprasong Hospital were randomized into three groups. The participants received the treatments daily for three consecutive days. The primary outcome was breast milk volume at 72 hours after delivery. Secondary outcomes were pregnancy and neonatal outcomes, adverse events, and participant satisfaction. Results Of the 1,450 pregnant women that underwent cesarean delivery, 120 women were enrolled. Their mean age and gestational ages were 28.7 years and 38.4 weeks, respectively. Breast milk volume at 72 hours postpartum was significantly different among the three groups (p = 0.030). The post hoc Bonferroni correction indicated a significant difference in breast milk volume between Wang Nam Yen herbal tea group and placebo control group (p = 0.007) while there was no difference between Wang Nam Yen herbal tea group and domperidone group (p = 0.806) and between domperidone group and placebo control group (p = 0.018). There was no difference in pregnancy and neonatal outcomes, adverse events, and participant satisfaction among the three groups. Conclusion Wang Nam Yen herbal tea was effective in augmenting breast milk production at 72 hours postpartum in mothers following cesarean delivery, and there was no evidence that herbal tea and domperidone differed in terms of augmenting breast milk production. Trial registration The study was approved by the institutional review board of Sunpasitthiprasong Hospital (No.061/2559) and was registered TCTR20170811003 with the Thai Clinical Trial Registry.
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Affiliation(s)
- Koollachart Saejueng
- Department of Obstetrics and Gynecology, Bandung Crown Prince Hospital, Udon Thani, Thailand
| | - Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Wattanaporn Khumbun
- Department of Thai Traditional and Alternative Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
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Foong SC, Tan ML, Foong WC, Marasco LA, Ho JJ, Ong JH. Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants. Cochrane Database Syst Rev 2020; 5:CD011505. [PMID: 32421208 PMCID: PMC7388198 DOI: 10.1002/14651858.cd011505.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many women express concern about their ability to produce enough milk, and insufficient milk is frequently cited as the reason for supplementation and early termination of breastfeeding. When addressing this concern, it is important first to consider the influence of maternal and neonatal health, infant suck, proper latch, and feeding frequency on milk production, and that steps be taken to correct or compensate for any contributing issues. Oral galactagogues are substances that stimulate milk production. They may be pharmacological or non-pharmacological (natural). Natural galactagogues are usually botanical or other food agents. The choice between pharmacological or natural galactagogues is often influenced by familiarity and local customs. Evidence for the possible benefits and harms of galactagogues is important for making an informed decision on their use. OBJECTIVES To assess the effect of oral galactagogues for increasing milk production in non-hospitalised breastfeeding mother-term infant pairs. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Health Research and Development Network - Phillippines (HERDIN), Natural Products Alert (Napralert), the personal reference collection of author LM, and reference lists of retrieved studies (4 November 2019). SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs (including published abstracts) comparing oral galactagogues with placebo, no treatment, or another oral galactagogue in mothers breastfeeding healthy term infants. We also included cluster-randomised trials but excluded cross-over trials. DATA COLLECTION AND ANALYSIS We used standard Cochrane Pregnancy and Childbirth methods for data collection and analysis. Two to four review authors independently selected the studies, assessed the risk of bias, extracted data for analysis and checked accuracy. Where necessary, we contacted the study authors for clarification. MAIN RESULTS Forty-one RCTs involving 3005 mothers and 3006 infants from at least 17 countries met the inclusion criteria. Studies were conducted either in hospitals immediately postpartum or in the community. There was considerable variation in mothers, particularly in parity and whether or not they had lactation insufficiency. Infants' ages at commencement of the studies ranged from newborn to 6 months. The overall certainty of evidence was low to very low because of high risk of biases (mainly due to lack of blinding), substantial clinical and statistical heterogeneity, and imprecision of measurements. Pharmacological galactagogues Nine studies compared a pharmacological galactagogue (domperidone, metoclopramide, sulpiride, thyrotropin-releasing hormone) with placebo or no treatment. The primary outcome of proportion of mothers who continued breastfeeding at 3, 4 and 6 months was not reported. Only one study (metoclopramide) reported on the outcome of infant weight, finding little or no difference (mean difference (MD) 23.0 grams, 95% confidence interval (CI) -47.71 to 93.71; 1 study, 20 participants; low-certainty evidence). Three studies (metoclopramide, domperidone, sulpiride) reported on milk volume, finding pharmacological galactagogues may increase milk volume (MD 63.82 mL, 95% CI 25.91 to 101.72; I² = 34%; 3 studies, 151 participants; low-certainty evidence). Subgroup analysis indicates there may be increased milk volume with each drug, but with varying CIs. There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints, such as tiredness, nausea, headache and dry mouth (very low-certainty evidence). No adverse effects were reported for infants. Natural galactagogues Twenty-seven studies compared natural oral galactagogues (banana flower, fennel, fenugreek, ginger, ixbut, levant cotton, moringa, palm dates, pork knuckle, shatavari, silymarin, torbangun leaves or other natural mixtures) with placebo or no treatment. One study (Mother's Milk Tea) reported breastfeeding rates at six months with a concluding statement of "no significant difference" (no data and no measure of significance provided, 60 participants, very low-certainty evidence). Three studies (fennel, fenugreek, moringa, mixed botanical tea) reported infant weight but could not be meta-analysed due to substantial clinical and statistical heterogeneity (I2 = 60%, 275 participants, very low-certainty evidence). Subgroup analysis shows we are very uncertain whether fennel or fenugreek improves infant weight, whereas moringa and mixed botanical tea may increase infant weight compared to placebo. Thirteen studies (Bu Xue Sheng Ru, Chanbao, Cui Ru, banana flower, fenugreek, ginger, moringa, fenugreek, ginger and turmeric mix, ixbut, mixed botanical tea, Sheng Ru He Ji, silymarin, Xian Tong Ru, palm dates; 962 participants) reported on milk volume, but meta-analysis was not possible due to substantial heterogeneity (I2 = 99%). The subgroup analysis for each intervention suggested either benefit or little or no difference (very low-certainty evidence). There was limited reporting of adverse effects, none of which could be meta-analysed. Where reported, they were limited to minor complaints such as mothers with urine that smelled like maple syrup and urticaria in infants (very low-certainty evidence). Galactagogue versus galactagogue Eight studies (Chanbao; Bue Xue Sheng Ru, domperidone, moringa, fenugreek, palm dates, torbangun, moloco, Mu Er Wu You, Kun Yuan Tong Ru) compared one oral galactagogue with another. We were unable to perform meta-analysis because there was only one small study for each match-up, so we do not know if one galactagogue is better than another for any outcome. AUTHORS' CONCLUSIONS Due to extremely limited, very low certainty evidence, we do not know whether galactagogues have any effect on proportion of mothers who continued breastfeeding at 3, 4 and 6 months. There is low-certainty evidence that pharmacological galactagogues may increase milk volume. There is some evidence from subgroup analyses that natural galactagogues may benefit infant weight and milk volume in mothers with healthy, term infants, but due to substantial heterogeneity of the studies, imprecision of measurements and incomplete reporting, we are very uncertain about the magnitude of the effect. We are also uncertain if one galactagogue performs better than another. With limited data on adverse effects, we are uncertain if there are any concerning adverse effects with any particular galactagogue; those reported were minor complaints. High-quality RCTs on the efficacy and safety of galactagogues are urgently needed. A set of core outcomes to standardise infant weight and milk volume measurement is also needed, as well as a strong basis for the dose and dosage form used.
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Affiliation(s)
- Siew Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - May Loong Tan
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Wai Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Lisa A Marasco
- Santa Barbara County Public Health Department, Nutrition Services/Breastfeeding Program, Santa Maria, California, USA
| | - Jacqueline J Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Joo Howe Ong
- C/O Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
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Taylor A, Logan G, Twells L, Newhook LA. Human Milk Expression After Domperidone Treatment in Postpartum Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Hum Lact 2019; 35:501-509. [PMID: 30481478 DOI: 10.1177/0890334418812069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Insufficient milk production is among the most cited reasons by mothers for discontinuing breastfeeding. Medications that can increase milk production, such as domperidone, an off-label galactagogue, are often prescribed. Domperidone is controversial as it is not approved for any purpose in the United States and is approved only for gastrokinetic purposes in Canada and other countries. RESEARCH AIM The aim was to update the existing literature on the efficacy of domperidone as a galactagogue compared to placebo when given to mothers with insufficient human milk production. The primary outcome is the change in expressed human milk volume per day from baseline. METHODS The authors independently searched the literature from inception to May 2018. The search included any randomized controlled trials examining the efficacy of domperidone increasing mothers' expressed human milk, measured via a human milk pump. Both authors independently assessed quality and risk of bias and extracted relevant data. Meta-analysis on expressed human milk volume per day was performed. RESULTS Seven studies met the inclusion criteria for review; two were excluded from the meta-analysis due to quality grading and insufficient reporting of the outcome of interest. Five studies (N = 239) were combined in the meta-analysis. The effect size showed an increase in the mean difference of expressed human milk volume in mothers given domperidone, 93.97 mL per day (95% CI [71.12, 116.83 mL]; random effect, T2 0.00, I2 0%). CONCLUSION This meta-analysis reports a significant improvement in expressed human milk volume per day with the use of domperidone in mothers experiencing insufficient human milk production.
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Affiliation(s)
- Alicia Taylor
- 1 Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Gabrielle Logan
- 1 Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Laurie Twells
- 1 Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Leigh Anne Newhook
- 2 Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Grzeskowiak LE, Wlodek ME, Geddes DT. What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?-A Narrative Review. Nutrients 2019; 11:nu11050974. [PMID: 31035376 PMCID: PMC6567188 DOI: 10.3390/nu11050974] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/23/2022] Open
Abstract
Inadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve breastfeeding outcomes. For women who continue to experience insufficient milk supply despite the utilisation of non-pharmacological lactation support strategies, pharmacological intervention with medications used to augment lactation, commonly referred to as galactagogues, is common. Galactagogues exert their pharmacological effects through altering the complex hormonal milieu regulating lactation, particularly prolactin and oxytocin. This narrative review provides an appraisal of the existing evidence regarding the efficacy and safety of pharmaceutical treatments for lactation insufficiency to guide their use in clinical practice. The greatest body of evidence surrounds the use of domperidone, with studies demonstrating moderate short-term improvements in breast milk supply. Evidence regarding the efficacy and safety of metoclopramide is less robust, but given that it shares the same mechanism of action as domperidone it may represent a potential treatment alternative where domperidone is unsuitable. Data on remaining interventions such as oxytocin, prolactin and metformin is too limited to support their use in clinical practice. The review provides an overview of key evidence gaps and areas of future research, including the impacts of pharmaceutical galactagogues on breast milk composition and understanding factors contributing to individual treatment response to pharmaceutical galactagogues.
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Affiliation(s)
- Luke E Grzeskowiak
- Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia.
- SA Pharmacy, Flinders Medical Centre, SA Health, Bedford Park, Adelaide, SA 5042, Australia.
| | - Mary E Wlodek
- Department of Physiology, The University of Melbourne, Melbourne, VIC 3010, Australia.
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, WA 6009, Australia.
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5
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do Nascimento AF, Thompsom B, Dell'Armelina Rocha PR, Kirychuk S, Bernardi MM, Felicio LF. Hyperprolactinemia Impaired the Effects of Lipopolysaccharide on Both Body Temperature and Sickness Behavior in Virgin Female Rats. Neuroimmunomodulation 2019; 26:285-291. [PMID: 31935743 DOI: 10.1159/000505096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Previously we observed an attenuation of body temperature in lactating rats treated with lipopolysaccharide (LPS) compared with virgin saline-treated females. We proposed that high levels of prolactin (PRL) during lactation may induce this attenuation because PRL has a suppressive effect on inflammation. In the present study, we induced hyperprolactinemia in female virgin rats to investigate the effects of PRL on body temperature and sickness behavior induced by LPS. METHODS To induce hyperprolactinemia, female rats in the estrous phase received domperidone 3 times/day for 5 days and an LPS injection (D + LPS group). Two other groups were treated with saline solution for 5 days, and one of them received a saline injection (S + S group) and the other LPS (S + LPS group). Tympanic temperature was assessed 0, 2, 4, 6, 8, 10, 24, 48, 72, and 96 h after treatment. Body weight gain and food and water consumption were observed 24, 48, 72, and 96 h after treatment. RESULTS Hyperprolactinemia impaired LPS-induced hypothermia and hyperthermia phases of body temperature. Body weight gains in the S + LPS group and the D + LPS group were similar. A decrease in food consumption was observed in the D + LPS rats at 72 and 96 h compared to the S + LPS group. CONCLUSION Hyperprolactinemia impaired the body temperature increase induced by LPS and several signs of sickness behavior, suggesting that febrile responses to LPS can be modulated by the physiological state. These phenomena may have adaptive value for reproduction.
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Affiliation(s)
- Amanda Florentina do Nascimento
- Medicine/Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brooke Thompsom
- Medicine/Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Shelley Kirychuk
- Medicine/Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Maria Martha Bernardi
- Graduate Program of Environmental and Experimental Pathology, Paulista University, São Paulo, Brazil,
| | - Luciano Freitas Felicio
- Department of Pathology, School of Veterinary Medicine, University of São Paulo, São Paulo, Brazil
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Asztalos EV. Supporting Mothers of Very Preterm Infants and Breast Milk Production: A Review of the Role of Galactogogues. Nutrients 2018; 10:E600. [PMID: 29757199 PMCID: PMC5986480 DOI: 10.3390/nu10050600] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 01/25/2023] Open
Abstract
Human milk, either mother’s own milk or donor human milk, is recommended as the primary source of nutrition for very preterm infants. Initiatives should be in place in neonatal units to provide support to the mother as she strives to initiate and maintain a supply of breast milk for her infant. The use of galactogogues are considered when these initiatives alone may not be successful in supporting mothers in this endeavor. Although there are non-pharmacologic compounds, this review will focus on the pharmacologic galactogogues currently available and the literature related to their use in mothers of very preterm infants.
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Affiliation(s)
- Elizabeth V Asztalos
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, M4N 3M5 Toronto, ON, Canada.
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7
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Grzeskowiak LE, Smithers LG, Amir LH, Grivell RM. Domperidone for increasing breast milk volume in mothers expressing breast milk for their preterm infants: a systematic review and meta-analysis. BJOG 2018; 125:1371-1378. [DOI: 10.1111/1471-0528.15177] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 12/29/2022]
Affiliation(s)
- LE Grzeskowiak
- Adelaide Medical School; The Robinson Research Institute; The University of Adelaide; Adelaide SA Australia
- Flinders Medical Centre; SA Pharmacy; SA Health; Adelaide SA Australia
| | - LG Smithers
- School of Public Health; The University of Adelaide; Adelaide SA Australia
| | - LH Amir
- Judith Lumley Centre; La Trobe University; Melbourne Vic. Australia
- The Royal Women's Hospital; Parkville Vic. Australia
| | - RM Grivell
- Adelaide Medical School; The Robinson Research Institute; The University of Adelaide; Adelaide SA Australia
- School of Medicine; Flinders University; Adelaide SA Australia
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Hondeghem LM, Logghe NH. Should Domperidone be Used as a Galactagogue? Possible Safety Implications for Mother and Child. Drug Saf 2017; 40:109-113. [PMID: 27900667 DOI: 10.1007/s40264-016-0478-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Domperidone has been used as a galactagogue; however, solid evidence from an adequate sized randomized clinical trial is missing. Optimal dosage, start of treatment, length of treatment and scope of patients who can benefit also remain unknown. Although milk obtained after domperidone administration has not been shown to have untoward effects on newborns, no sufficiently large randomized clinical trial has been done to establish safety. Domperidone has repeatedly been shown to produce sudden cardiac death, starting at 30 mg/day. Because of this known cardiac effect, the use of domperidone to increase breast milk production may not be justified.
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Haase B, Taylor SN, Mauldin J, Johnson TS, Wagner CL. Domperidone for Treatment of Low Milk Supply in Breast Pump-Dependent Mothers of Hospitalized Premature Infants: A Clinical Protocol. J Hum Lact 2016; 32:373-81. [PMID: 26905341 DOI: 10.1177/0890334416630539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/06/2016] [Indexed: 12/30/2022]
Abstract
Mothers of hospitalized premature infants who choose to provide breast milk are at increased risk of an inadequate breast milk supply. When nonpharmacologic interventions to increase milk supply fail, clinicians are faced with limited options. There is no current evidence to support the use of herbal galactogogues in this population and a black box warning for metoclopramide for potential serious side effects. Thus, domperidone was the only known, effective option for treatment of low milk supply in this population. With a thorough review of the literature on domperidone and coordination with the obstetrical, neonatal, lactation, and pharmacology teams, a domperidone treatment protocol for mothers of hospitalized premature infants with insufficient milk supply was developed at our institution and is presented in this article. A comprehensive understanding of domperidone for use as a galactogogue with a standard treatment protocol will facilitate safer prescribing practices and minimize potential adverse reactions in mothers and their hospitalized premature infants.
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Affiliation(s)
- Barbara Haase
- Department of Women and Children's Services, Medical University of South Carolina, Charleston, SC, USA
| | - Sarah N Taylor
- Division of Neonatology, Department of Pediatrics Medical University of South Carolina, Charleston, SC, USA
| | - Jill Mauldin
- Maternal Fetal Medicine and Medical Director of Women's Care Services, Medical University of South Carolina, Charleston, SC
| | - Teresa S Johnson
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics Medical University of South Carolina, Charleston, SC, USA
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Smolina K, Morgan SG, Hanley GE, Oberlander TF, Mintzes B. Postpartum domperidone use in British Columbia: a retrospective cohort study. CMAJ Open 2016; 4:E13-9. [PMID: 27280111 PMCID: PMC4866923 DOI: 10.9778/cmajo.20150067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Domperidone is commonly used off-label to stimulate milk production in mothers who have low milk supply. The aim of this study was to describe trends, patterns and determinants of postpartum domperidone use. METHODS This is a retrospective, population-based study involving all women with a live birth between Jan. 1, 2002, and Dec. 31, 2011, in the province of British Columbia. We examined administrative data sets containing person-specific information on filled prescriptions and use of medical services, and we used logistic regression to examine associations between domperidone use and maternal characteristics. RESULTS The study population consisted of 225 532 women with 320 351 live births. The prevalence of postpartum domperidone use more than doubled between 2002 and 2011. In 2011, 1 in 3 women with a preterm birth and 1 in 5 women with a full-term birth were prescribed domperidone in the first 6 months postpartum. Women who were older, had a higher body mass index, had a chronic disease, were first-time mothers, delivered more than 1 baby (multiple pregnancy), had a preterm birth or had a cesarian delivery were more likely to fill a postpartum domperidone prescription. INTERPRETATION We found an increase in postpartum domperidone use over a 10-year period. More research is needed on maternal and infant health outcomes.
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Affiliation(s)
- Kate Smolina
- School of Population and Public Health (Smolina, Morgan); Department of Obstetrics and Gynaecology (Hanley); Child & Family Research Institute (Oberlander), University of British Columbia, Vancouver, BC; Faculty of Pharmacy and Charles Perkins Centre (Mintzes), University of Sydney, Australia
| | - Steven G Morgan
- School of Population and Public Health (Smolina, Morgan); Department of Obstetrics and Gynaecology (Hanley); Child & Family Research Institute (Oberlander), University of British Columbia, Vancouver, BC; Faculty of Pharmacy and Charles Perkins Centre (Mintzes), University of Sydney, Australia
| | - Gillian E Hanley
- School of Population and Public Health (Smolina, Morgan); Department of Obstetrics and Gynaecology (Hanley); Child & Family Research Institute (Oberlander), University of British Columbia, Vancouver, BC; Faculty of Pharmacy and Charles Perkins Centre (Mintzes), University of Sydney, Australia
| | - Tim F Oberlander
- School of Population and Public Health (Smolina, Morgan); Department of Obstetrics and Gynaecology (Hanley); Child & Family Research Institute (Oberlander), University of British Columbia, Vancouver, BC; Faculty of Pharmacy and Charles Perkins Centre (Mintzes), University of Sydney, Australia
| | - Barbara Mintzes
- School of Population and Public Health (Smolina, Morgan); Department of Obstetrics and Gynaecology (Hanley); Child & Family Research Institute (Oberlander), University of British Columbia, Vancouver, BC; Faculty of Pharmacy and Charles Perkins Centre (Mintzes), University of Sydney, Australia
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11
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Fais P, Vermiglio E, Laposata C, Lockwood R, Gottardo R, De Leo D. A case of sudden cardiac death following Domperidone self-medication. Forensic Sci Int 2015; 254:e1-3. [PMID: 26119456 DOI: 10.1016/j.forsciint.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/20/2015] [Accepted: 06/04/2015] [Indexed: 11/18/2022]
Abstract
The phenomenon of sudden cardiac death is usually related to the worsening of existing heart conditions leading to ventricular arrhythmia (VA). One of the well-known triggers of SCD is drug-induced prolongation of the QT interval, such as that caused by Domperidone (D). Despite its risk to prolong the QT interval and associated narrow therapeutic index, D is available as an over-the-counter (OTC) drug in many countries such as Italy, Ireland, Netherlands, China, South Africa, Mexico, New Zealand and Chile to treat gastroesophageal reflux and functional dyspepsia. The present paper reports a case of SCD that occurred some hours after D self-administration in a 47-year-old female subject with mitral valve prolapse, thus, predisposed to both VA and SCD. Despite the risks related to D administration, to the best of our knowledge, this particular issue has not been discussed in the medico-legal literature. For this reason, the forensic implications of D administration are discussed focusing on issues related to the self-administration as an OTC drug (as seen in this case), administration to incapacitated subjects, prescription to patients with contraindications and the off-label drug use of D at high and hazardous concentrations to stimulate lactation.
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Affiliation(s)
- Paolo Fais
- University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy.
| | - Elisa Vermiglio
- University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy
| | - Chiara Laposata
- University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy
| | - Robert Lockwood
- University of New Haven, Department of Forensic Science, 300 Boston Post Road, West Haven, CT 06516, USA
| | - Rossella Gottardo
- University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy
| | - Domenico De Leo
- University of Verona, Department of Public Health and Community Medicine - Unit of Forensic Medicine, P.le L.A. Scuro 10, Verona, Italy
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Paul C, Zénut M, Dorut A, Coudoré MA, Vein J, Cardot JM, Balayssac D. Use of domperidone as a galactagogue drug: a systematic review of the benefit-risk ratio. J Hum Lact 2015; 31:57-63. [PMID: 25475074 DOI: 10.1177/0890334414561265] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breastfeeding is the optimal method for feeding a newborn. However, some mothers may have difficulties lactating. Domperidone is widely used as a galactagogue but to the best of our knowledge has not been approved by any health authority. The objective of this review was to assess the benefit-risk ratio of domperidone for stimulating lactation. The benefit-risk ratio of domperidone as a galactagogue was assessed following a literature search of the PubMed database up to July 2013. Four studies were selected to assess domperidone efficacy and demonstrated an increased milk production. The limited data (60 mother-baby pairs) and the moderate methodological quality of 1 study remain insufficient to conclude on domperidone efficacy. Regarding the safety of domperidone, 7 studies were selected that exposed 113 infants to domperidone through breastfeeding. No adverse effects were observed in 85 infants, and no information was provided for the remaining 28. The limited data available remain in favor of a safe domperidone profile in infants and mothers. However, in large studies focused on gastrointestinal disorders, domperidone is responsible for drug-induced long QT syndrome and sudden cardiac death. The use of domperidone as a galactagogue is worrisome as drug-induced long QT syndrome occurred mostly in women. In these circumstances, an improvement of breastfeeding practices seems to be more effective and safer than the use of an off-label domperidone treatment.
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Affiliation(s)
- Catherine Paul
- Université d'Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France
| | - Marie Zénut
- CHU Clermont-Ferrand, Centre Regional de Pharmacovigilance, Clermont-Ferrand, France EA 4681 PEPRADE, Université d'Auvergne, Clermont-Ferrand, France
| | - Agnès Dorut
- CHU Clermont-Ferrand, Service d'Obstétrique, Clermont-Ferrand, France
| | - Marie-Ange Coudoré
- Université d'Auvergne, Faculté de Pharmacie, Laboratoire de Physiologie, Clermont-Ferrand, France CHU Clermont-Ferrand, Hématologie Biologique, Clermont-Ferrand, France
| | - Julie Vein
- INSERM U1107, NEURO-DOL, Université d'Auvergne, Clermont-Ferrand, France
| | - Jean-Michel Cardot
- Université d'Auvergne, Faculté de Pharmacie, Laboratoire de Biopharmacie, Clermont-Ferrand, France CHU Clermont-Ferrand, INSERM CIC 1405, Centre de Pharmacologie Clinique, Clermont-Ferrand, France
| | - David Balayssac
- INSERM U1107, NEURO-DOL, Université d'Auvergne, Clermont-Ferrand, France CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, Clermont-Ferrand, France
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13
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Sensitive determination of domperidone in biological fluids using a conductive polymer modified glassy carbon electrode. Electrochim Acta 2015. [DOI: 10.1016/j.electacta.2014.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Doggrell SA, Hancox JC. Cardiac safety concerns for domperidone, an antiemetic and prokinetic, and galactogogue medicine. Expert Opin Drug Saf 2013; 13:131-8. [PMID: 24147629 DOI: 10.1517/14740338.2014.851193] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Domperidone is a dopamine D2-receptor antagonist developed as an antiemetic and prokinetic agent. Oral domperidone is not approved in the United States, but it is used in many countries to treat nausea and vomiting, gastroparesis and as a galactogogue (to promote lactation). The US Food and Drug Administration (FDA) have issued a warning about the cardiac safety of domperidone. AREAS COVERED The authors undertook a review of the cardiac safety of oral domperidone. EXPERT OPINION The data from preclinical studies are unambiguous in identifying domperidone as able to produce marked hERG channel inhibition and action potential prolongation at clinically relevant concentrations. The compound's propensity to augment instability of action potential duration and action potential triangulation are also indicative of proarrhythmic potential. Domperidone should not be administered to subjects with pre-existing QT prolongation/LQTS, subjects receiving drugs that inhibit CYP3A4, subjects with electrolyte abnormalities or with other risk factors for QT-prolongation. With these provisos, it is possible that domperidone may be used as a galactogogue without direct risk to healthy breast feeding women, but more safety information should be sought in this situation. Also, more safety information is required regarding risk to breast feeding infants before domperidone is routinely used in gastroparesis or gastroesphageal reflux in children.
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Affiliation(s)
- Sheila A Doggrell
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health , Brisbane, QLD4002 , Australia +61 7 3138 2015 ; +61 7 3138 1534 ;
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15
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Papastergiou J, Abdallah M, Tran A, Folkins C. Domperidone withdrawal in a breastfeeding woman. Can Pharm J (Ott) 2013; 146:210-2. [PMID: 23940477 DOI: 10.1177/1715163513492928] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Knoppert DC, Page A, Warren J, Seabrook JA, Carr M, Angelini M, Killick D, Dasilva OP. The effect of two different domperidone doses on maternal milk production. J Hum Lact 2013; 29:38-44. [PMID: 22554679 DOI: 10.1177/0890334412438961] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The benefits of breast milk to the newborn infant are well established. The Canadian Paediatric Society recommends exclusive breastfeeding for the first 6 months of life for healthy, term infants. Mothers of premature newborns, however, may have difficulty providing an adequate supply of breast milk. Domperidone is officially used as a prokinetic agent. However, it is used widely around the world as a galactogogue. Despite its widespread use as a galactogogue, only a small number of investigators have studied domperidone for this indication. AIMS The purpose of this study was to determine an optimal dosage of domperidone as a galactogogue. METHODS Eligible subjects were randomized to receive domperidone 10 mg 3 times daily or domperidone 20 mg 3 times daily for 4 weeks. At week 5, the frequency was decreased to twice daily in both groups, and finally once daily for week 6. RESULTS Over the entire first 4-week period, there was a significant increase in daily milk volumes within each group (P < .01). The between-group difference over this period, although not statistically significant, was clinically significant. Additionally, there was no significant within- or between-group difference during weeks 5 and 6. CONCLUSION A dose of domperidone of 20 mg, 3 times daily instead of 10 mg, 3 times daily was associated with a clinical, but not statistically significant, increase in milk production.
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Affiliation(s)
- David C Knoppert
- Pharmacy Services, London Health Sciences Centre, London, Ontario, Canada.
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17
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Grzeskowiak LE, Lim SW, Thomas AE, Ritchie U, Gordon AL. Audit of domperidone use as a galactogogue at an Australian tertiary teaching hospital. J Hum Lact 2013; 29:32-7. [PMID: 23015150 DOI: 10.1177/0890334412459804] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Domperidone is often used to promote lactation among women who have difficulty breastfeeding. OBJECTIVE To examine prescribing and dispensing practices of domperidone at the Women's and Children's Hospital (WCH), Adelaide. METHODS A retrospective audit of domperidone dispensing among women with singleton pregnancies who delivered at the WCH between January 2000 and July 2010 was undertaken. Women dispensed domperidone were identified using WCH pharmacy dispensing records. Maternal and infant clinical data were obtained from the WCH Perinatal Statistics Collection. An audit of paper-based medical records was undertaken for a random sample of 261 mother-child pairs to collect prescribing and additional clinical data. RESULTS From 2000 to 2010, 1605 women were dispensed domperidone. There was a steady increase in the percentage of women dispensed domperidone, from < 0.5% in 2000 to > 5% of total WCH pregnancies in 2010. Among women dispensed domperidone, the percentage of women who received > 1 dispensing remained consistent (20%) over time, as did the median number of days (12) from delivery to first dispensing. Multiparous women were more likely to receive domperidone within 3 days following delivery compared to primiparous women (8% vs 4%; P < .01). Most women (80%) received directions to take domperidone according to a standard tapering dosing regimen over 12 days. Notably, 60% of women had no documentation of being assessed by a lactation consultant. CONCLUSION From 2000 to 2010, there was a considerable increase in domperidone dispensing. With a lack of clinical evidence to guide use, current practice appears to be based on anecdotal evidence.
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Affiliation(s)
- Luke E Grzeskowiak
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
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Forinash AB, Yancey AM, Barnes KN, Myles TD. The use of galactogogues in the breastfeeding mother. Ann Pharmacother 2012; 46:1392-404. [PMID: 23012383 DOI: 10.1345/aph.1r167] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review data regarding the efficacy of galactogogues available in the US to increase breast milk production in postpartum mothers. DATA SOURCES Literature was sought using PubMed (1966-June 2012) and EMBASE (1973-June 2012). Search terms included breastfeeding, breast milk, lactation, galactogogue, metoclopramide, oxytocin, fenugreek, milk thistle, silymarin, growth hormone, thyroid releasing hormone, medroxyprogesterone, domperidone, goat's rue, beer, Asparagus racemosus, shatavari, Medicago sativa, alfalfa, Onicus benedictus, blessed thistle, Galega officinalis, brewer's yeast, and herbals. STUDY SELECTION AND DATA EXTRACTION All studies including humans and published in English with data assessing the efficacy of galactogogues for increasing breast milk production were evaluated. DATA SYNTHESIS Breast milk is considered the optimal food source for newborns through 1 year of age. Many factors influence overall maternal production, including maternal pain, illness, balance of time when returning to work, anxiety, or emotional stress. Although a variety of herbal and pharmaceutical options have anecdotal evidence of their ability to improve breast milk production, peer-reviewed studies proving their efficacy are lacking. Metoclopramide, oxytocin, fenugreek, and milk thistle have shown mixed results in improving milk production; however, the trials were small and had a variety of limitations. CONCLUSIONS Nonpharmacologic recommendations should be exhausted before adding therapy. Although anecdotal evidence encourages the use of metoclopramide, fenugreek, asparagus, and milk thistle for their galactogogue properties, efficacy and safety data in the literature are lacking. Oxytocin and domperidone are potentially available for compounding purposes, but safety data are limited. More studies are needed to evaluate the effects of available galactogogues on breast milk production.
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Affiliation(s)
- Alicia B Forinash
- Department of Pharmacy Practice, St. Louis College of Pharmacy, MO, USA.
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Asztalos EV, Campbell-Yeo M, daSilva OP, Kiss A, Knoppert DC, Ito S. Enhancing breast milk production with Domperidone in mothers of preterm neonates (EMPOWER trial). BMC Pregnancy Childbirth 2012; 12:87. [PMID: 22935052 PMCID: PMC3532128 DOI: 10.1186/1471-2393-12-87] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 08/13/2012] [Indexed: 11/11/2022] Open
Abstract
Background The use of mother’s own breast milk during initial hospitalization has a positive impact not only in reducing potential serious neonatal morbidities but also contribute to improvements in neurodevelopmental outcomes. Mothers of very preterm infants struggle to maintain a supply of breast milk during their infants’ prolonged hospitalization. Galactogogues are medications that induce lactation by exerting its effects through oxytocin or prolactin enhancement. Domperidone is a potent dopamine D2 receptor antagonist which stimulates the release of prolactin. Small trials have established its ability in enhancing breast milk production. EMPOWER was designed to determine the safety and efficacy of domperidone in mothers experiencing an inadequate milk supply. Methods/design EMPOWER is a multicenter, double masked, randomized controlled phase-II trial to evaluate the safety and effectiveness of domperidone in those mothers identified as having difficulty in breast milk production. Eligible mothers will be randomized to one of two allocated groups: Group A: domperidone 10 mg orally three times daily for 28 days; and Group B: identical placebo 10 mg orally three times daily for 14 days followed by domperidone 10 mg orally three times daily for 14 days. The primary outcome will be determined at the completion of the first 2-week period; the second 2-week period will facilitate answering the secondary questions regarding timing and duration of treatment. To detect an estimated 30% change between the two groups (from 40% to 28%, corresponding to an odds ratio of 0.6), a total sample size of 488 mothers would be required at 80% power and alpha = 0.05. To account for a 15% dropout, this number is increased to 560 (280 per group). The duration of the trial is expected to be 36–40 months. Discussion The use of a galactogogue often becomes the measure of choice for mothers in the presence of insufficient breast milk production, particularly when the other techniques are unsuccessful. EMPOWER is designed to provide valuable information in guiding the practices for this high-risk group of infants and mothers. The results of this trial will also inform both mothers and clinicians about the choices available to increase and maintain sufficient breast milk. Trial registration Clinical Trials.gov Identifier: NCT01512225
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Affiliation(s)
- Elizabeth V Asztalos
- Department of Newborn & Developmental Paediatrics, University of Toronto, Centre for Mother, Infant, Child Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
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Effect of domperidone on insufficient lactation in puerperal women: a systematic review and meta-analysis of randomized controlled trials. Obstet Gynecol Int 2012; 2012:642893. [PMID: 22461793 PMCID: PMC3306907 DOI: 10.1155/2012/642893] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 10/06/2011] [Indexed: 11/18/2022] Open
Abstract
Background. There is a controversy within the medical community regarding the role of domperidone as a galactagogue and the drug has been removed from the US market owing to safety concerns. Objective. To perform a systematic review and meta-analysis of the available data assessing the effect of domperidone on breast milk production in women experiencing insufficient lactation. Study Selection. Randomized controlled trials (RCTs) examining the effect of domperidone on breast milk production of puerperal women were eligible for inclusion. Data Analysis. Absolute and relative changes from baseline were calculated for individual studies and pooled using a random effects model. Results. Three RCTs including 78 participants met the inclusion criteria. All showed a statistically significant increase in breast milk production following treatment with domperidone. The analysis of pooled data demonstrated a statistically significant relative increase of 74.72% (95% CI = 54.57; 94.86, P < 0.00001) in daily milk production with domperidone treatment compared to placebo. No maternal or neonatal adverse events were observed in any of the trials. Conclusions. Evidence from a few small RCTs of moderate to high quality suggests that domperidone produces a greater increase in breast milk supply than placebo.
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21
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Jantarasaengaram S, Sreewapa P. Effects of domperidone on augmentation of lactation following cesarean delivery at full term. Int J Gynaecol Obstet 2011; 116:240-3. [PMID: 22189066 DOI: 10.1016/j.ijgo.2011.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 10/10/2011] [Accepted: 11/23/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the effects of domperidone on breast milk production in women who underwent cesarean at full term. METHODS Women who underwent uncomplicated full-term cesarean were randomly assigned to receive domperidone or placebo for 4 consecutive days post partum. Breast milk was collected twice daily via electric breast pump. Baseline milk production was determined by measuring the volume of milk collected on the 1st postpartum day, before initiation of study medication (day 0). The daily volume of milk collected was compared between groups. Adverse treatment-related effects were recorded. RESULTS The study was completed by 22 women in the domperidone group and 23 in the placebo group. Compared with day 0, mean increases in milk volume per participant collected on days 1, 2, 3, and 4 were significantly higher in the domperidone (13.6 ± 23.2 mL, 68.5 ± 71.9 mL, 144.5 ± 122.3 mL, and 191.3 ± 136.1 mL) than in the placebo (2.5 ± 4.6 mL, 24.5 ± 26.5 mL, 72.1 ± 55.6 mL, and 91.4 ± 60.3 mL) group. Minor adverse effects were reported by 7 women in the domperidone group. CONCLUSION Postpartum treatment with domperidone can augment breast milk production after full-term cesarean, with minimal adverse effects.
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Affiliation(s)
- Surasak Jantarasaengaram
- Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
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Powe CE, Allen M, Puopolo KM, Merewood A, Worden S, Johnson LC, Fleischman A, Welt CK. Recombinant human prolactin for the treatment of lactation insufficiency. Clin Endocrinol (Oxf) 2010; 73:645-53. [PMID: 20718766 PMCID: PMC6488522 DOI: 10.1111/j.1365-2265.2010.03850.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Lactation insufficiency has many aetiologies including complete or relative prolactin deficiency. Exogenous prolactin may increase breast milk volume in this subset. We hypothesized that recombinant human prolactin (r-hPRL) would increase milk volume in mothers with prolactin deficiency and mothers of preterm infants with lactation insufficiency. DESIGN Study 1: R-hPRL was administered in an open-label trial to mothers with prolactin deficiency. Study 2: R-hPRL was administered in a randomized, double-blind, placebo-controlled trial to mothers with lactation insufficiency that developed while pumping breast milk for their preterm infants. PATIENTS Study 1: Mothers with prolactin deficiency (n = 5). Study 2: Mothers of premature infants exclusively pumping breast milk (n = 11). DESIGN Study 1: R-hPRL (60 μg/kg) was administered subcutaneously every 12 h for 28 days. Study 2: Mothers of preterm infants were randomized to receive r-hPRL (60 μg/kg), placebo or r-hPRL alternating with placebo every 12 h for 7 days. MEASUREMENTS Change in milk volume. RESULTS Study 1: Peak prolactin (27·9 ± 17·3 to 194·6 ± 19·5 μg/l; P < 0·003) and milk volume (3·4 ± 1·6 to 66·1 ± 8·3 ml/day; P < 0·001) increased with r-hPRL administration. Study 2: Peak prolactin increased in mothers treated with r-hPRL every 12 h (n = 3; 79·3 ± 55·4 to 271·3 ± 36·7 μg/l; P < 0·05) and daily (101·4 ± 61·5 vs 178·9 ± 45·9 μg/l; P < 0·04), but milk volume increased only in the group treated with r-hPRL every 12 h (53·5 ± 48·5 to 235·0 ± 135·7 ml/day; P < 0·02). CONCLUSION Twice daily r-hPRL increases milk volume in mothers with prolactin deficiency and in preterm mothers with lactation insufficiency.
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Affiliation(s)
- Camille E Powe
- Harvard Medical School Reproductive Endocrine Unit, Brigham and Women's Hospital, Boston University Medical School, Boston, MA, USA
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Campbell-Yeo ML, Allen AC, Joseph KS, Ledwidge JM, Caddell K, Allen VM, Dooley KC. Effect of domperidone on the composition of preterm human breast milk. Pediatrics 2010; 125:e107-14. [PMID: 20008425 DOI: 10.1542/peds.2008-3441] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Domperidone is increasingly prescribed to improve breast milk volume despite a lack of evidence regarding its effects on breast milk composition. We examined the effect of domperidone on the nutrient composition of breast milk. PATIENTS AND METHODS Forty-six mothers who had delivered infants at <31 weeks' gestation, who experienced lactation failure, were randomly assigned to receive domperidone or placebo for 14 days. Protein, energy, fat, carbohydrate, sodium, calcium, and phosphate levels in breast milk were measured on days 0, 4, 7, and 14, serum prolactin levels were measured on days 0, 4, and 14, and total milk volume was recorded daily. Mean within-subject changes in nutrients and milk volumes were examined. RESULTS Maternal and infant characteristics, serum prolactin level, and breast milk volume and composition were not significantly different between domperidone and placebo groups on day 0. By day 14, breast milk volumes increased by 267% in the domperidone-treated group and by 18.5% in the placebo group (P = .005). Serum prolactin increased by 97% in the domperidone group and by 17% in the placebo group (P = .07). Mean breast milk protein declined by 9.6% in the domperidone group and increased by 3.6% in the placebo group (P = .16). Changes in energy, fat, carbohydrate, sodium, and phosphate content were also not significantly different between groups. Significant increases were observed in breast milk carbohydrate (2.7% vs -2.7%; P = .05) and calcium (61.8% vs -4.4%; P = .001) in the domperidone versus placebo groups. No significant adverse events were observed among mothers or infants. CONCLUSION Domperidone increases the volume of breast milk of preterm mothers experiencing lactation failure, without substantially altering the nutrient composition.
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Wan EWX, Davey K, Page-Sharp M, Hartmann PE, Simmer K, Ilett KF. 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; 66:283-9. [PMID: 18507654 PMCID: PMC2492930 DOI: 10.1111/j.1365-2125.2008.03207.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Accepted: 04/08/2008] [Indexed: 11/28/2022] Open
Abstract
AIMS To investigate the possibility of a dose-response relationship for the use of domperidone in treating insufficient milk supply in mothers of preterm infants, and to quantify the exposure of the breastfed infant to domperidone. METHODS Six preterm mothers received domperidone (30 mg daily or 60 mg daily) in a double-blind, randomized, crossover trial. Milk production and serum prolactin were measured before and during the trial, and domperidone concentration in milk was measured during drug treatment. RESULTS For milk production, two of the mothers were 'nonresponders', whereas the other four were 'responders' and showed a significant increase in milk production from 8.7 +/- 3.1 g h(-1) in the run-in phase (mean +/- SEM), 23.6 +/- 3.9 g h(-1) for the 30-mg dose (P = 0.0217) and 29.4 +/- 6.6 g h(-1) for the 60-mg dose (P = 0.0047). In all participants, serum prolactin was significantly increased for both doses, but the response was not dose dependent. Median (interquartile range) domperidone concentrations in milk over a dose interval at steady-state were 0.28 microg l(-1) (0.24-0.43) and 0.49 microg l(-1) (0.33-0.72) for the 30-mg and 60-mg doses, respectively. The mean relative infant dose was 0.012% at 30 mg daily and 0.009% at 60 mg daily. CONCLUSION In one-third of mothers, domperidone did not increase milk production. In the remainder, milk production increased at both domperidone doses, and there was a trend for a dose-response relationship. The amount of domperidone that transfers into milk was extremely low, and infant exposure via breastfeeding was not considered to be significant.
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Affiliation(s)
- Elise W-X Wan
- Pharmacology and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia
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Sakha K, Behbahan AG. Training for perfect breastfeeding or metoclopramide: which one can promote lactation in nursing mothers? Breastfeed Med 2008; 3:120-3. [PMID: 18564001 DOI: 10.1089/bfm.2007.0020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND One of the most common complaints of nursing mothers in a few days after delivery is insufficient lactation. This is known to be partly due to the mothers' deficient knowledge of proper breastfeeding and often results in the beginning of bottlefeeding, which finally diminishes or ceases their breastfeeding. Considering the valuable effects of breastfeeding on nutritional, immunologic, and emotional aspects of infants' health, we planned this study to find out whether training of nursing mothers for breastfeeding can enhance their lactation; also, we tried to compare the effects of metoclopramide on lactation with those of training. METHODS Throughout 2006, we consecutively enrolled 20 primipara nursing mothers who were referred to Tabriz Children's Hospital, Tabriz, Iran for counseling about prescription of infant formula as a response to their complaint of insufficient lactation during a couple of months after parturition. Only those mothers were included in this study whose newborns had failed to gain appropriate weight, determined by their age and birth weight. First, all newborns were weighed, and all mothers passed a short training course about "perfect practice of breastfeeding"; then we randomly allocated them in two equal groups of 10 mothers-one group received a metoclopramide tablet (10 mg/dose every 8 hours), and the other just placebo, both for a period of 15 days. Thereafter we weighed the newborns again and compared the two recorded weights of each infant and the average weight of the two groups with each other to assess the sufficiency of breastfeeding and effects of training and galactogogue. RESULTS Eighteen of the 20 newborns studied (90%) showed an appropriate weight gain: 12 newborns gained 385-415 g (mean, 400 +/- 15 g), six neonates gained 270-315 g (mean, 292.5 +/- 22.5 g), but the remaining two newborns gained 150-235 g (mean, 192.5 +/- 42.5 g). Statistical analysis revealed that training of nursing mothers for perfect breastfeeding (with or without metoclopramide consumption) has a significant improving role in infants' weight gain (p < 0.001); however, there was no statistically meaningful difference between the two treatment groups (with and without administration of metoclopramide, p = 0.68). CONCLUSIONS Counseling nursing mothers for proper lactation before delivery and their continued training thereafter are the main clinical pathways toward a successful and sustained breastfeeding.
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Affiliation(s)
- K Sakha
- Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
Use of plant and drug products to enhance lactation is widespread, and numerous papers have been published in the medical literature claiming efficacy for various products. This paper will review and evaluate the published literature on the most widely used pharmaceuticals that are used as galactagogues. Breastfeeding physiology is reviewed with the aim of creating a framework for understanding galactagogue pharmacology. Published articles were selected and evaluated using the principles of evidence-based medicine, and were also evaluated using the principles of good lactation management. Only three studies on oxytocin and seven studies on dopamine antagonists were found to be useful. Oxytocin is probably not useful as a galactagogue, except possibly in rare circumstances of tetraplegic mothers. Dopamine antagonists appear not to enhance milk supply if mothers are given good lactation support and employ these practices. The safety of the dopamine antagonists has not been adequately evaluated, so their use should be avoided unless other measures have failed.
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Affiliation(s)
- Philip O Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California 92093-0657, USA.
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Page-Wilson G, Smith PC, Welt CK. Short-term prolactin administration causes expressible galactorrhea but does not affect bone turnover: pilot data for a new lactation agent. Int Breastfeed J 2007; 2:10. [PMID: 17650319 PMCID: PMC1950489 DOI: 10.1186/1746-4358-2-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 07/24/2007] [Indexed: 11/18/2022] Open
Abstract
Background Medications used to augment lactation increase prolactin secretion but can have intolerable side effects. We examined the biological activity of recombinant human prolactin (r-hPRL) as preliminary data for its use to augment lactation. Methods Healthy, non-postpartum women (n = 21) with regular menstrual cycles underwent a seven day randomized, double-blind, placebo-controlled trial of r-hPRL. Expressible galactorrhea, markers of bone turnover, calcium homeostasis and gonadal function were measured and side effects recorded. Results Prolactin levels increased during r-hPRL administration (20.0 ± 2.8 to 231.7 ± 48.9 μg/L at 6 hours; p < 0.05). Five of nine participants who received r-hPRL developed expressible galactorrhea (p < 0.001). Urinary deoxypyridinoline decreased and bone specific alkaline phosphatase increased in r-hPRL and placebo groups. Menstrual cycle lengths were not altered and side effects were similar between r-hPRL and placebo groups. Conclusion In summary, r-hPRL can cause expressible galactorrhea. Seven days of r-hPRL administration does not adversely affect bone turnover or menstrual cyclicity. Thus, r-hPRL may be a viable option for short-term lactation augmentation. Trial registration Clinical Trials.gov NCT00438490
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Affiliation(s)
- Gabrielle Page-Wilson
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Patricia C Smith
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, USA
| | - Corrine K Welt
- Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, USA
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Campbell-Yeo ML, Allen AC, Joseph KS, Ledwidge JM, Allen VM, Dooley KC. Study protocol: a double blind placebo controlled trial examining the effect of domperidone on the composition of breast milk [NCT00308334]. BMC Pregnancy Childbirth 2006; 6:17. [PMID: 16719919 PMCID: PMC1562444 DOI: 10.1186/1471-2393-6-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 05/23/2006] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Domperidone, a drug that enhances upper gastric motility, is an anti-dopaminergic medication that also elevates prolactin levels. It has been shown to safely increase the milk supply of lactating women. To date, researchers have analyzed the effects of domperidone on lactating woman with respect to the quantity of their milk production, adverse effects, and drug levels in the breast milk. However, the effect of domperidone on the macronutrient composition of breast milk has not been studied and current guidelines for fortification of human milk for premature infants do not distinguish between those women using or those not using domperidone. The purpose of this study is to evaluate the effect of domperidone (given to lactating mothers of very preterm infants) on the macronutrient composition of breast milk. METHODS/DESIGN Mothers of infants delivered at less than 31 weeks gestation, who are at least 3 weeks postpartum, and experiencing lactational failure despite non-pharmacological interventions, will be randomized to receive domperidone (10 mg three times daily) or placebo for a 14-day period. Breast milk samples will be obtained the day prior to beginning treatment and on days 4, 7 and 14. The macronutrient (protein, fat, carbohydrate and energy) and macromineral content (calcium, phosphorus and sodium) will be analyzed and compared between the two groups. Additional outcome measures will include milk volumes, serum prolactin levels (measured on days 0, 4, and 10), daily infant weights and breastfeeding rates at 2 weeks post study completion and at discharge. Forty-four participants will be recruited into the study. Analysis will be carried out using the intention to treat approach. DISCUSSION If domperidone causes significant changes to the nutrient content of breast milk, an alteration in feeding practices for preterm infants may need to be made in order to optimize growth, nutrition and neurodevelopment outcomes.
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Affiliation(s)
- Marsha L Campbell-Yeo
- Neonatal Intensive Care Unit, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
- Doctoral Candidate, McGill University, Quebec, Canada
| | - Alexander C Allen
- Neonatal Intensive Care Unit, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
- the Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - K S Joseph
- the Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joyce M Ledwidge
- Neonatal Intensive Care Unit, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Victoria M Allen
- the Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynecology and Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kent C Dooley
- Laboratory Services, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
Section 1 describes the benefits of breastfeeding to both mother and infant as well as the potential risks to the infant from maternal drug use. The extent of adverse drug-related events and the need for quality information on drug transfer is stated. Section 2 describes the physiology of lactation and the effects of drugs that stimulate or decrease milk production. Section 3 deals with transport mechanisms for drug passage into milk and factors that may modify the infant's exposure to drugs. The critical descriptors of 'absolute' and 'relative' infant dose are defined to give an objective measure of infant exposure to drugs in milk. Section 4 reviews new or commonly used drugs under the headings of analgesics and anti-inflammatory agents, neurological, endocrine, psychotropic and antihypertensive drugs. Section 5 concludes with an expert opinion of the drug industry and drug use in lactation, herbal preparations, the process of 'risk-benefit' analysis, minimising infant exposure, understanding drug-related adverse events and fostering good experimental design for drugs in lactation studies.
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Affiliation(s)
- Kenneth F Ilett
- University of Western Australia, School of Medicine and Pharmacology, Crawley, 6009, Australia.
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Affiliation(s)
- Thomas W Hale
- Division of Clinical Pharmacology, Texas Tech University School of Medicine, 1400 Wallace Blvd., Amarillo, TX 79106, USA
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Abstract
Breastfeeding provides ideal nutrition, growth hormones, and antibodies that change over time as growing infants' and children's needs change and provides these inexpensively, with no harm to the environment. Breastfed infants are healthier than other infants overall, and research indicates that the health benefits may continue on into adulthood. Increasingly, women are choosing to initiate breastfeeding in the hospital, but the attrition starts early and is dramatic. For women to meet their breastfeeding goals, physicians must not only give lip service to "breast is best" but also become knowledgeable in breastfeeding management and actively promote breastfeeding in their practices and in their communities.
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Affiliation(s)
- N E Wight
- Division of Neonatology, Children's Hospital and Health Center, San Diego, California, USA.
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Biervliet FP, Maguiness SD, Hay DM, Killick SR, Atkin SL. Induction of lactation in the intended mother of a surrogate pregnancy: case report. Hum Reprod 2001; 16:581-3. [PMID: 11228232 DOI: 10.1093/humrep/16.3.581] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A case of a successful induction of lactation in a commissioning mother of a surrogate pregnancy is reported. Induction of lactation was achieved with oral metoclopramide which was well tolerated. Alternative methods to induce lactation are reviewed. The advantages of breast-feeding and the relative ease with which lactation can be induced after a surrogate pregnancy would suggest that this could be offered to all commissioning mothers.
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Affiliation(s)
- F P Biervliet
- Department of Reproductive Medicine, The University of Hull, UK.
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Livingstone VH, Gout PW, Crickmer SD, Fox K, Prior JC. Serum lactogens possessed normal bioactivity in patients with lactation insufficiency. Clin Endocrinol (Oxf) 1994; 41:193-8. [PMID: 7923823 DOI: 10.1111/j.1365-2265.1994.tb02529.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Insufficient breast milk is the most common reason for premature termination of breast-feeding. The causes of lactation insufficiency are usually multifactorial; in a small percentage of cases it is due to primary lactation failure of unknown origin. The aim of this study was to investigate whether lactation insufficiency of unknown origin could be caused by serum lactogens that had reduced biological activity. DESIGN Women with lactation insufficiency of unknown origin and normal lactating controls were subjected to a standardized breast-feeding test for assessment of milk production. Thirty minutes later, serum samples were obtained for determination of total lactogen bioactivity, using an in-vitro bioassay, and levels of prolactin (PRL) and growth hormone (GH) using radioimmunoassay (RIA). PATIENTS Twelve lactating mothers with a clinical diagnosis of lactation insufficiency of unknown origin were compared with 12 matched mothers with normal lactation. MEASUREMENTS The Nb2 lymphoma cell bioassay was used to measure total lactogen bioactivity in sera. Conventional RIA kits were used to estimate serum PRL and GH concentrations. RESULTS Mean milk yield on standardized test feed was 21.6 ml for patients and 146.5 ml for controls. In both patient and control groups the total serum lactogen bioactivity ranged from about 150 to 5000 mIU/l, while the serum RIA (PRL+GH) levels ranged from about 350 to over 7000 mIU/l. There was no evidence of lactogens with reduced bioactivity in the patients' sera. CONCLUSION Lactation insufficiency in the women studied cannot be explained by serum lactogens that possess unusually low bioactivity.
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Affiliation(s)
- V H Livingstone
- Department of Family Practice, University of British Columbia, Canada
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