Goat's rue and domperidone in mother with microprolactinoma

[Annie Brown]

Working with a mother of a 7 week old with suppressed lactation due to infant sucking problems, which are being treated concurrently. Pumping is somewhat painful so keeping suction low. She was diagnosed with a microprolactinoma in Feb 2021, took cabergoline until she became pregnant. Can she safely take goat's rue or domperidone to increase supply?

[kaytlin]

To be clear-- MICRO- or MACRO-prolactinemia? We usually use cabergoline for macroprolactinomas....in this case, domperidone will not increase her milk production. Goat's rue doesn't have any evidence to support breastfeeding claims, so I don't recommend it either. Unfortunately, we don't have any options for lactation failure in macroprolactinemia right now.

Kaytlin Krutsch, PharmD

[Annie Brown]

Hi Kaytlin, thanks for your response. She reports microprolactinoma with no symptoms other than amenorrhea after stopping oral contraceptives. Cabergoline was used to help restore fertility. Is it safe to trial domperidone for this mother? She is making about 18oz per day at present.

[kaytlin]

Hi Annie,

Dr. Hale and I have done some more investigation and cleared up our confusion. Micro- and Macro-prolactinOMAs both produce macroprolactinEMIA. Domperidone will NOT help in these instances (and may make the situation worse). Domperidone increases prolactin--as her prolactin levels are likely extremely high, a further increase in prolactin will not help increase milk production.

Kaytlin Krutsch, PharmD

[Annie Brown]

Thank you Kaytlin for your response. Can you explain when you say 'make the situation worse?' Thanks!

[kaytlin]

It could worsen her symptoms of macroprolactinemia (like headaches or changes in vision, libido, or possibly bone density).

The microprolactinoma and decreased dopaminergic inhibition of prolactin secretion both independently contribute to elevated prolactin in normal situations. In this situation, the removal of dopaminergic inhibition (domperidone) on a prolactin-producing tumor could result in an enormous amount of prolactin being released.

[Annie Brown]

I had a feeling that's what would happen but wanted to clarify for my own knowledge. Thank you so very much.