Τόμος 37 (2019) – Τεύχος 2 – Άρθρο 7 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση – Volume 37 (2019) – Issue 2 – Article 7 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

Ο πιο συχνός λόγος για τη διακοπή του θηλασμού είναι η μειωμένη  παραγωγή  γάλακτος. Για τον λόγο αυτό χρησιμοποιούνται τα γαλακταγωγά φάρμακα στη γαλουχία.   Τα γαλακταγωγά είναι φάρμακα ή άλλες ουσίες που πιστεύεται ότι βοηθούν στην έναρξη, τη συντήρηση ή την αύξηση της παροχής μητρικού γάλακτος. Η δομπεριδόνη και η μετοκλοπραμίδη  είναι  τα πιο συχνά χρησιμοποιούμενα φαρμακευτικά γαλακταγωγά. Και τα δύο είναι ανταγωνιστές  ντοπαμίνης που αυξάνουν την έκκριση  προλακτίνης.  Επίσης, έχουν χρησιμοποιηθεί και πολλά φυτικά φάρμακα  για την ενίσχυση της παραγωγής γάλακτος όπως η Fenugreek   (Τριγωνέλλα ) και  η Silymarina  (Γαιδουράγκαθο).

Οι κλινικοί ιατροί θα πρέπει να συνταγογραφούν γαλακταγωγά  με την κατάλληλη προσοχή όσον αφορά τις αλληλεπιδράσεις μεταξύ  φαρμάκων (ή φαρμάκων  σε  βότανα), καθώς και μια συνολική προσέγγιση κινδύνου-οφέλους . Η στενή παρακολούθηση τόσο της μητέρας όσο και του βρέφους είναι απαραίτητη για την παρακολούθηση της κατάστασης της γαλουχίας καθώς και των ανεπιθύμητων ενεργειών του φαρμάκου στη μητέρα ή στο βρέφος. Ο FDA στις ΗΠΑ έχει ρητά συστήσει κατά της χρήσης της δομπεριδόνης και μετοκλοπραμίδης για την αύξηση της παραγωγής γάλακτος στη γαλουχία.

The most common reason for stopping breastfeeding is reduced milk production. For this reason, galactogogues are used in lactation. Galactogogues are medications or other substances believed to assist initiation, maintenance, or augmentation of maternal milk supply. Domperidone and metoclopramide are the most commonly used pharmaceutical galactogogues  at present. Both are dopamine antagonists that increase prolactin secretion. Also many  herbal remedies have been used throughout history to enhance milk supply.   The most common  used herbal  galactogogues   are  fenugreek and Silybum .Clinicians should prescribe galactogogues with appropriate caution with regard 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 infant is essential to monitor the status of lactation as well as any adverse effects of the drugs on the mother or infant . In the United States, the FDA has issued an advisory against the use of domperidone in lactating women.

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