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.
Nutrients. 2019 Apr 28;11(5):974. doi: 10.3390/nu11050974.
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.
母乳供应不足是母乳喂养早期中断的一个常见原因，也是改善母乳喂养结果的一个关键机会。对于那些尽管已经使用了非药物性的哺乳支持策略，但仍持续面临母乳供应不足的女性，药物干预，即常说的催乳剂，是常见的做法。催乳剂通过改变调节泌乳的复杂激素环境发挥其药理作用，特别是催乳素和催产素。本综述对现有的关于治疗哺乳期不足的药物治疗的疗效和安全性的证据进行评估，以指导其在临床实践中的应用。围绕多潘立酮的使用有最大的证据体，研究表明其在短期内可适度增加母乳供应。关于甲氧氯普胺疗效和安全性的证据则不那么充分，但鉴于它与多潘立酮具有相同的作用机制，因此在多潘立酮不适用的情况下，甲氧氯普胺可能是一种潜在的替代治疗方法。关于催产素、催乳素和二甲双胍等其他干预措施的数据非常有限，不足以支持其在临床实践中的应用。本综述概述了关键的证据空白和未来研究领域，包括药物催乳剂对母乳成分的影响，以及了解影响个体对药物催乳剂治疗反应的因素。
