NO DRUG THERAPY IN PRIMARY CARE (ASSESS FIRST)
Nearly every lactation problem is solved by watching a feed, not by prescribing. Poor attachment, infrequent or timed feeding, nipple pain, engorgement and tongue-tie account for most of what is reported as 'not enough milk'. Skilled breastfeeding support and more frequent, effective feeding raise supply. No medicine raises supply reliably. The cabergoline entry below is for the opposite problem - suppressing lactation when a mother is not going to breastfeed - and not for low supply. - Assess, then decide
Adult-only condition - paediatric section not applicable
No dose - assessment step, no medicine given
Domperidone is widely used off-label as a galactagogue and is deliberately not offered here: it is unlicensed for this purpose, the European and UK regulators restricted it over QT prolongation and sudden cardiac death, and the evidence for a clinically meaningful increase in supply is weak. Feeding support is what works.
- A red, painful, wedge-shaped area with fever is mastitis. Keep feeding or expressing from that breast, and add an antibiotic if it has not settled within 12-24 hours or the mother is unwell.
- A fluctuant lump that does not settle is a breast abscess - refer for drainage.
- Domperidone as a galactagogue is off-label and carries a cardiac warning. It is not recommended here.
- Failure of lactation after a delivery complicated by major haemorrhage, especially with fatigue and cold intolerance, raises Sheehan's syndrome. Check thyroid and pituitary function.
- Milk production that continues long after weaning, or in a woman who has not been pregnant, is galactorrhoea - check prolactin and thyroid function, and review her drug list.
- Watch the baby, not the breast. Wet nappies, weight gain along the centile and audible swallowing are what tell you the supply is adequate; the feel of the breast does not.