galactagogue

A galactagogue is any substance that promotes milk production and secretion in lactating individuals. Galactagogues can be natural, such as herbs and foods, or pharmaceutical agents prescribed under medical supervision. The term comes from Latin galact-, milk, and agogue, leading or inducing.

Mechanisms vary. Some increase prolactin levels by antagonizing dopamine receptors or by other hormonal pathways, while others influence milk ejection or mammary gland function. The quality of evidence varies widely across substances.

Common galactagogues include pharmacologic agents such as metoclopramide and domperidone, which can raise prolactin but carry safety concerns and are not suitable for routine use in all jurisdictions. Herbal galactagogues include fenugreek (Trigonella foenum-graecum), blessed thistle (Cnicus benedictus), and goat's rue (Galega officinalis).

Indications: used for perceived or diagnosed low milk supply when medical assessment rules out reversible causes and when breastfeeding supports are optimized. It should be part of a broader lactation management plan including latch, frequent feeding, pumping, and addressing maternal nutrition and health.

Safety and evidence: efficacy is variable; many substances lack robust trial data. Side effects range from gastrointestinal symptoms to more serious risks such as hypoglycemia, allergic reactions, or cardiac effects with some prescription agents. Some drugs are contraindicated in certain conditions; domperidone has been restricted in some countries due to cardiac risks; metoclopramide can cause extrapyramidal symptoms and sedation.

Regulation and usage: in many places, herbs are sold as dietary supplements with limited regulation; pharmaceutical use requires medical oversight. Patients should consult a clinician before starting any galactagogue.