by Anne Eglash MD, IBCLC, FABM
What medications and supplements are known to reduce the milk supply? There are several ways that substances can reduce the milk supply. Some medications increase dopamine, a neurotransmitter in the brain. Dopamine is known to reduce the prolactin level, so increasing dopamine can lead to a decrease this ‘work horse’ hormone for breastmilk production. Some medications decrease oxytocin, the ‘letdown’ hormone, and a few medications might decrease growth hormone, which also plays an important role in milk production. Some hormones have been found to block prolactin receptors, such that prolactin cannot be as effective at the breast. Several herbs have been found to decrease milk supply, but their mechanisms of action are not known.
What medications do you think have been found to decrease milk supply? Choose 1 or more:
- Epinephrine
- Labetolol
- High dose steroids (such as Solumedrol)
- Strong antihistamines such as diphenhydramine (Benadryl)
- Testosterone
- Estrogen
- Methylergonovine (Methergine)
- Pseudoephedrine (Sudafed)
- Aripiprazole (Abilify)
See the Answer
The answer is all except B, Labetolol
References:
1. Anderson PO Drugs that Suppress Lactation, Part 2. Breastfeeding Med 2017 May:12: 199-201
2. Toxnet- Lactmed
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Occasionally women are given medications that can interfere with their milk supply. A common clinical scenario is a woman who has an overwhelming allergic reaction to something, such as an antibiotic given to her for mastitis. Women who receive shots of high dose steroids, epinephrine, and strong antihistamines to manage an allergic reaction have a strong likelihood of experiencing a noticeable drop in their milk supply. From my experience, the supply will rebound over the next 7-10 days.
Another not-uncommon scenario is the woman given an estrogen-containing birth control pill at 6 weeks postpartum or later. Estrogen commonly drops the milk supply, and in fact I use estrogen medicinally to drop the milk supply for women who are over-producers. The rebound in milk supply after hormonal treatment is more challenging, from my experience.
Providers who care for breastfeeding women need to be aware of what medications can effect the milk supply. In a situation such as an allergic reaction, when the use of anti-lactation medications is unavoidable, the mother needs to be counseled on how to maximize her milk supply, and how to identify whether she needs to supplement her infant until her milk supply rebounds.
Yoo-Mi Chung
“who has an overwhelming allergic reaction to something, such as an antibiotic given to her for mastitis”
May I have references?
MilkMob
Allergic reactions such as hives, swelling, and anaphylaxis happen frequently in the United States. These allergic reactions often require epinephrine, diphenhydramine, and steroids, all of which reduce the milk supply.
Jennifer
Great discussion. As a health professional and IBCLC this has me wondering about how to advise mothers with serious allergies. As a woman who has serious allergies, when I was breastfeeding I was able to avoid my allergens. However, what if I hadn’t? Maybe encouraging breastfeeding mums who know they have a serious allergy to have some milk stored “just in case” would be a good idea. I know that with my food allergies, I wanted to reduce the risk of food allergies in my babies, so I maximised breastfeeding in the first 6 months and introduced allergens while breastfeeding. I didn’t know then about the impact of epinephrine (adrenaline in Oz) on milk supply, and if I had, I would have stockpiled milk for a “rainy day” i.e. for when I needed my epipen.
MilkMob
This is a good point. Women who are at risk for having an allergic reaction might want to talk to her primary care physician or allergist about options for treatment that won’t reduce the supply.
Dr. Lauren Spieler
Do you have a specific amount of peppermint or sage that you recommend to mom’s who have oversupply or at trying to wean? i’d like to provide handout with more details than just saying can try these herbs.
Anne Eglash
I will reply to your privately
Bethany
I take multiple allergy medications to keep my allergies under control. I wonder if that would have a similar effect to taking one strong medication. I also have to add a benadryl every so often when it is really bad. I had lost a lot of supply when I had very bad mastitis, and was not able to bring it back to where it had been. now allergy season is back and I have noticed slowly I have had to supplement more and more no matter how hard I work to bring it up.
Susan
does amlodipine or HCTZ 25 mg reduce lactation ?
IABLE
Amlodipine does not, but some people notice a drop in milk production with HCTZ