IBCLC EXAM- PHARMACOLOGY AND
TOXICOLOGY CORRECT 100%
Galactogogues (or lactagogues) - ANSWER medications or other substances believed
to assist initiation, maintenance, or augmentation of maternal milk supply
Why are Galactogogues used? - ANSWER to increase low (or perceived low) milk
supply
in mothers with preterm infants, where the aim has been to stimulate initial secretory
activation or augment declining milk secretion
Mothers who are not breastfeeding, but are expressing milk by hand or with a pump
in women inducing lactation when they have not been pregnant with the current child, in
women relactating after weaning, or in transgender women
most commonly used pharmaceutical galactogogues at present - ANSWER
Domperidone and metoclopramide
Both are dopamine antagonists that increase prolactin secretion
Other commonly used galactogogues - ANSWER Fenugreek, Silymarina
Herbals, Foods, and Beverages as Galactogogues - ANSWER fenugreek, goat's rue,
milk thistle (Silybum marianum), oats, dandelion, millet, seaweed, anise, basil, blessed
thistle, fennel seeds, marshmallow, moringa leaf, shatavari, and torbangun among
others
Galactogogues- evidence and risks - ANSWER While the fact that these herbs have
been used for centuries without apparent harm is reassuring, there is also little or no
scientific evidence for their effectiveness or safety.
It is important to note that caution is required for the use of herbal preparations because
of the lack of standardized dosing preparations (other than in research settings),
possible contaminants, allergic potential, and drug interactions
Practice Recommendations for low milk supply - ANSWER 1. Evaluate the mother for
medical causes of low milk supply
2. Assess and increase the frequency and effectiveness of milk removal.
3. ABM cannot recommend any specific galactogogue at this time.
4. If the healthcare provider chooses to prescribe a galactogogue after weighing
potential risks versus potential benefits of these agents, they should follow the
guidelines below.
a. Inform women about available data concerning efficacy, timing of use, and duration of
therapy, potential adverse effects of galactogogues.
, -Screen the mother for contraindications to, allergies to, or drug interactions with the
chosen medication or other substance.
medical causes of low milk supply: - ANSWER pregnancy, medications, primary
mammary glandular insufficiency, breast surgery, polycystic ovarian syndrome,
hypothyroidism, retained placenta, ingestion of placenta capsules, theca lutein cyst, loss
of prolactin secretion following postpartum hemorrhage, heavy smoking or alcohol use,
or other pertinent conditions.
Modifiable factors to address: - ANSWER maternal anxiety and mental health issues,
comfort and relaxation for the mother, frequency and effectiveness of milk removal, and
any underlying medical conditions.
Medication should never replace evaluation and counseling on modifiable factors.
Illicit drug use and legal substance use/abuse - ANSWER signify risk for the breastfed
infant, in addition to the drug exposure
Drug users are at high risk for infections such as human immunodeficiency virus and/or
hepatitis B and C.
Psychiatric disorders that require pharmacotherapeutic intervention are more prevalent
with substance use, as breastfeeding may not be recommended for women taking some
psychotropic medications.
drug-exposed infants, who are at a high risk for an array of medical, psychological, and
developmental issues, as well as their mothers, stand to benefit significantly from
breastfeeding.
Should mothers exposed to drugs and alcohol breastfeed? - ANSWER Although many
of the factors listed above may pose a risk to the infant, the documented benefits of
human milk and breastfeeding must be carefully and thoughtfully weighed against the
risks associated with the substance that the infant may be exposed to during lactation
research on individual drugs of abuse remains lacking and difficult to perform
Alcohol and counseling breastfeeding mothers - ANSWER Counsel mothers who wish
to drink occasional alcohol that alcohol easily transfers into human milk.
Recommendations from the American Academy of Pediatrics, the World Health
Organization, and others advise waiting 90-120 minutes after ingesting alcohol before
breastfeeding, or expressing and discarding milk within that time frame.
Marijuana and counseling breastfeeding mothers - ANSWER A recommendation of
abstaining from any marijuana use is warranted.
At this time, although the data are not strong enough to recommend not breastfeeding
with any marijuana use, we urge caution.
TOXICOLOGY CORRECT 100%
Galactogogues (or lactagogues) - ANSWER medications or other substances believed
to assist initiation, maintenance, or augmentation of maternal milk supply
Why are Galactogogues used? - ANSWER to increase low (or perceived low) milk
supply
in mothers with preterm infants, where the aim has been to stimulate initial secretory
activation or augment declining milk secretion
Mothers who are not breastfeeding, but are expressing milk by hand or with a pump
in women inducing lactation when they have not been pregnant with the current child, in
women relactating after weaning, or in transgender women
most commonly used pharmaceutical galactogogues at present - ANSWER
Domperidone and metoclopramide
Both are dopamine antagonists that increase prolactin secretion
Other commonly used galactogogues - ANSWER Fenugreek, Silymarina
Herbals, Foods, and Beverages as Galactogogues - ANSWER fenugreek, goat's rue,
milk thistle (Silybum marianum), oats, dandelion, millet, seaweed, anise, basil, blessed
thistle, fennel seeds, marshmallow, moringa leaf, shatavari, and torbangun among
others
Galactogogues- evidence and risks - ANSWER While the fact that these herbs have
been used for centuries without apparent harm is reassuring, there is also little or no
scientific evidence for their effectiveness or safety.
It is important to note that caution is required for the use of herbal preparations because
of the lack of standardized dosing preparations (other than in research settings),
possible contaminants, allergic potential, and drug interactions
Practice Recommendations for low milk supply - ANSWER 1. Evaluate the mother for
medical causes of low milk supply
2. Assess and increase the frequency and effectiveness of milk removal.
3. ABM cannot recommend any specific galactogogue at this time.
4. If the healthcare provider chooses to prescribe a galactogogue after weighing
potential risks versus potential benefits of these agents, they should follow the
guidelines below.
a. Inform women about available data concerning efficacy, timing of use, and duration of
therapy, potential adverse effects of galactogogues.
, -Screen the mother for contraindications to, allergies to, or drug interactions with the
chosen medication or other substance.
medical causes of low milk supply: - ANSWER pregnancy, medications, primary
mammary glandular insufficiency, breast surgery, polycystic ovarian syndrome,
hypothyroidism, retained placenta, ingestion of placenta capsules, theca lutein cyst, loss
of prolactin secretion following postpartum hemorrhage, heavy smoking or alcohol use,
or other pertinent conditions.
Modifiable factors to address: - ANSWER maternal anxiety and mental health issues,
comfort and relaxation for the mother, frequency and effectiveness of milk removal, and
any underlying medical conditions.
Medication should never replace evaluation and counseling on modifiable factors.
Illicit drug use and legal substance use/abuse - ANSWER signify risk for the breastfed
infant, in addition to the drug exposure
Drug users are at high risk for infections such as human immunodeficiency virus and/or
hepatitis B and C.
Psychiatric disorders that require pharmacotherapeutic intervention are more prevalent
with substance use, as breastfeeding may not be recommended for women taking some
psychotropic medications.
drug-exposed infants, who are at a high risk for an array of medical, psychological, and
developmental issues, as well as their mothers, stand to benefit significantly from
breastfeeding.
Should mothers exposed to drugs and alcohol breastfeed? - ANSWER Although many
of the factors listed above may pose a risk to the infant, the documented benefits of
human milk and breastfeeding must be carefully and thoughtfully weighed against the
risks associated with the substance that the infant may be exposed to during lactation
research on individual drugs of abuse remains lacking and difficult to perform
Alcohol and counseling breastfeeding mothers - ANSWER Counsel mothers who wish
to drink occasional alcohol that alcohol easily transfers into human milk.
Recommendations from the American Academy of Pediatrics, the World Health
Organization, and others advise waiting 90-120 minutes after ingesting alcohol before
breastfeeding, or expressing and discarding milk within that time frame.
Marijuana and counseling breastfeeding mothers - ANSWER A recommendation of
abstaining from any marijuana use is warranted.
At this time, although the data are not strong enough to recommend not breastfeeding
with any marijuana use, we urge caution.
