Prior to the use of a galactogogue, thorough evaluation should be performed of the entire feeding process by a lactation expert. Reassurance may be offered, if appropriate.
When intervention is indicated for the dyad, modifiable factors should be addressed: comfort and relaxation for the mother, frequency and thoroughness of milk removal, and underlying medical conditions. Medication should never replace evaluation and counseling on modifiable factors.
As new evidence has emerged regarding various interventions to increase milk secretion in lactating women, the case for using pharmaceutical galactogogues has grown weaker. There remain selected indications for which some of these agents may be useful, but the data are insufficient to make definitive recommendations.
One high-quality study has found domperidone useful in mothers of babies less than 31 weeks' gestation in the neonatal intensive care unit (see the Appendix).
Herbal galactogogues are problematic because of lack of regulation of preparations and insufficient evidence of efficacy and safety.
Clinicians should prescribe galactogogues with appropriate caution in regards to drug-to-drug (or drug-to-herb) interactions as well as an overall risk-to-benefit approach and complete informed consent.
Close follow-up of both mother and baby is essential to monitor the status of lactation as well as any adverse effects of the drug(s) on mother or infant.