Domperidon, hebal Galactalogues + Essential Thrombocytosis, Thyroiditis, Raynaud's

[LimorP]

Dr. Hale,

I’m scheduled for c-sec in 3 days, and had a history of low milk supply with 1st and 2nd child, after which I have become an IBCLC.

After having read your medication book, forum and other resources, I have a few questions:
1. Motilium (Domperidone)
Motilium did not increase my milk supply 6 years ago. Does it make sense to try again? Try higher dosage and/or longer time to take the medication?
(initial dosage of motilium was 6 *10 mg/day, then increased to 8*10 mg/day, for total of 4 weeks). Prolactin levels where not checked.

2. Goat’s rue - Are you aware of any contraindications with Essential Thrombocytosis or Raynaud's syndrome?

3. Fenugreek
3.1 In Motherlove herb guide it says:
“Fenugreek may lower the thyroid hormone T3 and is not recommended for women with hypothyroidism.“
In the past 3 years my thyroid was normal, but previously had some hypo and hyper – thyroidism (before and after deliveries).
So now that my thyroid is normal - can I take fenugreek after delivery (while checking that the TSH level is normal)?
3.2 In Motherlove herb guide it says:
“It has been speculated that the coumarin constituent in fenugreek may increase the effect of anticoagulants, but in human studies it did not affect platelet aggregation.“
So can I take the fenugreek after delivery, taking into account history of Essential Thrombocytosis and my medications (Interferon, Clexan in the first 6 weeks postpartum (40mg daily) and thereafter baby aspirin (83 mg daily)?

4. Nettle - In Motherlove herb guide it says:
“Hight vitamin K content may interfere with anti-clotting medication."
So can I take Nettle after delivery?

Detailed maternal medical history:
• Essential Thrombocytosis, diagnosed 15 years ago. Treated mostly with hydroxyurea. Before getting pregnant + during pregnancy + during breastfeeding treated with Interferon alfa 2b / Intron A (1.5 MIU * 3 /week)
• Raynaud's syndrome – very mild (not treated)
• Thyroiditis - had some fluctuations in TSH and FT4 before and after delivery of 1st and 2nd children.

Thank you!
Limor Pelled, IBCLC

[mmilla]

Dear Limor,
Domperidone only works if your prolactin level is low (in the <
20's range). Prolactin levels peak 45 minutes (at about 110 ng/mL) after
breastfeeding and then return to baseline 2-3 hours after breastfeeding
(50-70 ng/ml). To determine if prolactin is the source of your problem, I
would suggest you do plasma prolactin levels before using Domperidone. If
they are low, then domperidone will work. If they are high, it will not
work.

The best time to have your levels checked is 2-3 hours after a feeding.
Your baseline prolactin levels ( after 2 hours or so) should be above
approximately 50 ng/mL.

With regards to Goat's rue and Nettle, because they are herbal drugs and
not FDA regulated, we cannot comment on their safety. Millions of mothers
have used Fenugreek, but we still don't have any really good data that it
is effective.

I hope this is helpful.

Maria Milla, MD
InfantRisk Center

[deOmair]

I take the fenugreek after delivery, taking into account history of Essential Thrombocytosis and my medications (Interferon, Clexan in the first 6 weeks postpartum (40mg daily) and thereafter baby aspirin (83 mg daily)