TEMA 6. GALACTOGOGOS

6.1 FUNDAMENTOS E INDICACIONES

Los galactogogos o lactogogos (del griego “productores de leche”) son todos aquellos productos o procedimientos a los que se les atribuye la posibilidad de aumentar la producción de leche.

Se utilizan desde la antigüedad más remota y se encuentran en las prácticas de lactancia de sociedades recolectoras cazadoras actuales sin o con poco contacto con la sociedad industrial moderna, luego es de suponer que de siempre ha habido una preocupación por la posible insuficiencia de leche de las mujeres.

La percepción materna de falta de suficiente leche sea real o no, es una de las causas más frecuentes de abandono de la lactancia.

Tanto para saber cómo pueden actuar como para definir sus indicaciones, debemos, antes de pasar a verlos, repasar el mecanismo de producción de la leche, la fisiología de la lactancia.

Desgraciadamente debemos recordar que, en un entorno cultural hostil a la lactancia, como es el nuestro actual, la mayoría de las mujeres producen leche en cantidad adecuada a las necesidades de sus hijos e incluso de sobra: también desde la antigüedad aparecen recetas para disminuir la excesiva producción de leche.

Fisiología de la lactancia

La leche materna se produce en los alveolos mamarios y, una vez producida, es expulsada por los conductos galactóforos hacia el exterior a través del pezón. La leche la producen las células epiteliales o lactocitos del alveolo, que “filtran” sangre y plasma de los capilares y tejido intersticial que les rodea y la convierten en leche. Estos lactocitos dependen de la prolactina hipofisaria anterior para producir leche. La oxitocina, otra hormona de la hipófisis posterior es la que contrae las fibrillas musculares que rodean los alveolos para expulsar la leche.

Es el estímulo del pezón el que envía, a través de la rica red nerviosa que inerva la mama, una orden neuroendocrina que hace que la hipófisis segregue prolactina y oxitocina. Así, si no hay estimulo no hay prolactina y los lactocitos no producen leche y es este un reflejo dosisdependiente, es decir, a más estímulo, más producción.

En los primeros días y semanas, la producción depende casi por completo de la cantidad de prolactina que se produce, pero luego, aunque cada vez que se estimula el pecho al mamar, hay un pico de prolactina (mucho más pequeño que durante las primeras semanas), la producción depende más del propio pecho que, al drenarse, vuelve a producir leche, dependiendo menos de la prolactina.

El mejor galactogogo va a ser, por tanto, una extracción frecuente del pecho con un drenaje eficaz del mismo sea por el propio bebé, sea la madre con extracciones manuales o mecánicas (Brodribb 2018; Foong 2020).

La leche de inicio fluye al disminuir los altos niveles de progestágeno placentario. La prolactina es inhibida por la dopamina y la oxitocina por las hormonas del estrés y el dolor, las catecolaminas.

Asegurar la fisiología

Para que el mecanismo neuroendocrino que asegura la producción de leche funcione deben concurrir una serie de hechos:

El sistema endocrino y metabólico de la madre debe estar integro. Aparte de la prolactina y la oxitocina, otras hormonas y sus receptores correspondientes son necesarios para el buen funcionamiento del sistema: hormonas tiroideas, insulina, glucocorticoides, luteinizante, y un cierto equilibrio entre estrógenos y progesterona, por ejemplo. De hecho, un resto placentario secretando cantidades elevadas de progesterona, interfiere con la lactogénesis inicial.

El estímulo del pezón y el drenaje del pecho deben ser efectivos, frecuentes y no dolorosos para la madre: son claves unas técnicas de agarre y postura adecuadas.

El drenaje debe ser frecuente, a necesidad del bebé y del pecho de la madre. La madre debe estar descansada y libre de preocupaciones. Asimismo, debe evitar medicamentos y sustancias que disminuyan la producción de prolactina. Todo lo que aumenta la cantidad de dopamina, disminuye la de prolactina y viceversa.

El pecho debe estar bien formado para la lactancia, sin alteraciones anatómicas congénitas o adquiridas. (aplasia/hipoplasia, anomalía de Poland, cirugía o radiación previas). El lactante a su vez debe estar sano, sin problemas que le dificulten el mamar o la ganancia de peso.

6.2 TIPOS DE GALACTOGOGOS

• Dietas, alimentos y bebidas galactogogas
• Productos herbales
• Fármacos

6.2.1 Dietas, alimentos y bebidas galactogogas

La cerveza, desde la antigüedad hasta nuestros días tiene la reputación de ser galactogoga. Con el nacimiento de la publicidad moderna a finales del siglo XVIII, numerosas empresas cerveceras utilizan imágenes de nodrizas en sus carteles publicitarios. Es posible que el lúpulo o la levadura de la cerveza aumenten algo la prolactina, pero no hay trabajos científicos concluyentes al respecto y lo que sí está demostrado es que el alcohol además de sedar y perjudicar el desarrollo neurológico del lactante disminuye la producción láctea.

Numerosas dietas y diversos alimentos han sido empleados tradicionalmente en muchas culturas como galactogogos. Suelen ser platos ricos en calorías y proteínas en forma de sopas condimentadas con variados productos, como los atoles centroamericanos, las sopas de algas (algunas con exceso de yodo) y pollos de Extremo Oriente, o las de patas de cerdo en Korea. Más reciente el Ovomaltine® en Francia. Apenas hay confirmación científica alguna de su eficacia como galactogogos, con la excepción de los siguientes:

• El Coleus amboinicus o Plectranthus amboinicus conocido como orégano cubano, orégano francés, orégano brujo, menta mejicana, tomillo español o torbangun en Indonesia en cuya cocina se emplea como alimento en sopas para aumentar la producción de leche. Hay un ensayo aleatorizado que demuestra aumento de producción de leche frente a placebo, y más que frente a fenogreco. Dosis: 150 g de hojas de torbangun en sopa 6 días a la semana por 4 semanas.

• Dátiles de palma: Un ensayo aleatorizado que demuestra aumento de producción de leche frente a placebo, y más que frente a fenogreco en los primeros 7 días de vida. A los 14 días no había diferencias en los 3 grupos. Dosis: 10 dátiles al día (unos 100 g).

6.2.2 Galactogogos herbales y otros productos alternativos

Los galactogogos herbales se utilizan con frecuencia porque muchas madres los perciben como más naturales y, por tanto, más seguros. Sin embargo, la evidencia sobre su eficacia es heterogénea y en general de baja o muy baja certeza. Las revisiones sistemáticas disponibles muestran resultados mixtos, problemas metodológicos frecuentes —muestras pequeñas, mezcla de varios componentes, falta de cegamiento y gran heterogeneidad— y una notificación insuficiente de efectos adversos (Foong 2020). Por ello, conviene evitar presentar las plantas medicinales como intervenciones inocuas o claramente eficaces. Además, la composición de los suplementos comerciales puede variar entre fabricantes, y la estandarización de dosis y pureza no siempre está garantizada.

Con pocas o ninguna prueba científica de su efecto como galactogogo tenemos las siguientes plantas: albahaca, alfalfa, algas marinas, anís, avena, cardo bendito, diente de león, Euphorbia (ixbut en maya), hinojo, jengibre, malvavisco, manzanilla, mijo, moringa, ortiga, satavar (Shatavari, Asparagus racemosus) y sauzgatillo (árbol casto).

La mayoría de ellas tienen pocos, uno o ningún trabajo científico que haya testado su eficacia galactogénica. Entre las plantas de las que disponemos de trabajos científicos que han estudiado su eficacia como galactogogos y/o que son más populares en este sentido tenemos:

Fenogreco, fenugreco, alholva (Trigonella foenum-graecum)

El fenogreco es probablemente el galactogogo herbal más popular y el que más se ha estudiado. Aun así, la evidencia actual sigue siendo inconsistente. National Center for Complementary and Integrative Health (NCCIH) concluye que los estudios realizados en mujeres lactantes han mostrado resultados mixtos y que se necesitan estudios de mayor calidad antes de sacar conclusiones firmes. LactMed añade que un metaanálisis encontró un efecto galactogogo leve con perfil de seguridad incierto (Erarslan 2024), mientras que otro no encontró buena evidencia de eficacia (Cragg 2026).

En cuanto a la seguridad, el fenogreco suele tolerarse razonablemente bien, pero no está exento de efectos adversos. Se han descrito diarrea, flatulencia, náuseas, vómitos y reacciones alérgicas; también se ha advertido sobre posible reactividad cruzada con leguminosas como el cacahuete. Puede disminuir la glucemia y potenciar el efecto de anticoagulantes como la warfarina. Un efecto llamativo, aunque benigno, es el olor corporal y urinario a jarabe de arce. Una proporción relevante de madres no ha referido efectos adversos. (Lactmed 2026)

Dosis: infusión, polvo o semillas, 1 a 2 g tres veces al día durante 7 a 21 días.

En conclusión, el fenogreco puede tener un efecto modesto en algunas mujeres, pero la evidencia es limitada, heterogénea y no permite recomendarlo de forma generalizada.

Cardo mariano, cardo asnal, cardo borriquero (Silybum marianum)

El cardo mariano y su extracto estandarizado, la silimarina, se han utilizado tradicionalmente con fines hepatoprotectores y también como galactogogos. La actualización más reciente de LactMed indica que noexisten ensayos clínicos científicamente válidos que apoyen el uso del cardo mariano como galactogogo. Aunque algunos estudios con formulaciones específicas de silimarina o combinaciones con otros compuestos han mostrado actividad, esos resultados no pueden extrapolarse sin más al cardo mariano como planta o a cualquier suplemento comercial.

Desde el punto de vista de la seguridad, los datos disponibles sugieren que los componentes de la silimarina no se excretan en cantidades medibles en leche y que, por su escasa absorción oral, el riesgo para el lactante parece bajo. Aun así, se han descrito efectos adversos maternos leves, como diarrea, cefalea o reacciones cutáneas, y raramente alergias graves.

En la práctica, puede considerarse una planta de seguridad probablemente aceptable, pero con eficacia no demostrada de forma sólida como galactogogo.

Galega, Ruda Cabruna, Galega officinalis

La galega se ha empleado históricamente como galactogogo, pero la evidencia de eficacia es escasa y de calidad limitada. LactMed señala que parte de la información positiva procede de productos combinados —por ejemplo, preparados con silimarina y galega—, lo que impide atribuir el efecto a la galega de forma aislada.

Además, no debe considerarse una planta inocua. Existen casos de toxicidad en recién nacidos y madres tras el consumo de infusiones herbales mixtas que incluían galega, y LactMed recuerda que sus derivados guanidínicos pueden producir hipoglucemia. Por ello, conviene evitar presentarla como una opción de uso libre o rutinario (Sahin 2016, Rosti 1994).

6.2.3 Galactogogos farmacológicos

Numerosos productos farmacológicos se han ensayado para aumentar la producción de leche. Antes de los avances de la Farmacología moderna y la comprensión del mecanismo de producción de la leche, los productos comercializados a mediados del siglo XX con este fin eran de composición peregrina, mezcla de azucares y productos reconstituyentes, cuyas propiedades galactogogas eran nulas. Como ejemplo citamos Plasmon® y Moloco® en Italia, Imperial Granum® en USA, Heparnovina® y Ceregumil® en España, Lactagol® en Francia, HipofosfoSalud® en Argentina y tantos otros desprovistos de todo poder galactógeno.

Desde la aparición en la segunda mitad del siglo XX de drogas neurolépticas, como la clorpromazina (1950) y otras como la Sulpirida (1964), la Metoclopramida (1964), y la Domperidona (1974) se apreciaron sus efectos secundarios entre los que se hallaba el de producir galactorrea por aumento de prolactina, causado al ser antagonistas de la dopamina. Sin embargo, un aumento de prolactina no garantiza un incremento clínicamente relevante de la producción de leche, especialmente cuando la frecuencia y eficacia del vaciamiento mamario no son adecuadas.

Dada la fisiología de la lactancia que hemos explicado, todos ellos tienen mayor efectividad dentro de la tres a cuatro primeras semanas de lactancia. Veamos algunos de los más utilizados en opción fuera de indicación:

Metoclopramida

La metoclopramida se ha utilizado durante décadas como galactogogo, pero la valoración actual es bastante más prudente que en textos antiguos. LactMed 2026 resume que, en estudios bien diseñados realizados en mujeres en las que ya se habían optimizado las técnicas de lactancia, la metoclopramida no aportó beneficio adicional. Además, varios metaanálisis concluyen que, aunque puede aumentar la prolactina, no incrementa de forma consistente el volumen de leche y confirma que no fue mejor que placebo (Si 2024, Shen 2021, Hussain 2021).

Su perfil de seguridad obliga también a cautela. LactMed advierte que debe evitarse en mujeres con antecedente de depresión mayor y no utilizarse durante periodos prolongados, ya que las madres en el posparto tienen especial vulnerabilidad a la depresión y, además, existe riesgo de efectos extrapiramidales y discinesia tardía con usos más prolongados. Entre los efectos adversos descritos figuran cansancio, náuseas, cefalea, diarrea, sequedad de boca, ansiedad, irritabilidad, palpitaciones y síntomas neurológicos.

En leche se excreta en cantidad variable; la mayoría de los lactantes reciben menos del 10% de la dosis materna ajustada por peso, pero algunos pueden alcanzar niveles farmacológicamente activos. Por ello, si se utilizara de forma excepcional, debería hacerse a la menor dosis eficaz y durante pocos días, sabiendo que no existe una pauta oficialmente establecida para aumentar la producción de leche. Muchas publicaciones han usado 10 mg 2–3 veces al día durante 7–14 días, a veces con retirada progresiva; no hay respaldo para dosis mayores, tratamientos más largos ni ciclos repetidos.

En consecuencia, hoy la metoclopramida no debería presentarse como galactogogo de elección ni como opción de uso rutinario (Si 2024).

Domperidona

La domperidona es el galactogogo farmacológico con mejor respaldo relativo, pero su eficacia tampoco debe sobredimensionarse. LactMed 2026 concluye que puede aumentar la producción de leche de forma aguda, sobre todo en madres de prematuros, con incrementos medios del orden de 90–94 mL/día, y que el metaanálisis más reciente la sitúa por encima de placebo solo en ese grupo. La red metaanálisis de 2024 coincide: en madres de prematuros la domperidona aumentó el volumen de leche frente a placebo y metoclopramida, pero en madres de recién nacidos a término no mostró un beneficio claro.

La transferencia a la leche es muy baja. LactMed estima que el lactante recibiría menos del 0,1% de la dosis materna ajustada por peso, incluso con dosis altas, y en los casospublicados no se han descrito efectos adversos relevantes en los lactantes expuestos a través de la leche.

El principal problema de la domperidona es la seguridad materna. LactMed advierte que dosis superiores a 30 mg/día pueden aumentar el riesgo de arritmias y muerte súbita en personas susceptibles, especialmente con antecedentes de arritmia, prolongación del QT o uso concomitante de fármacos que también prolongan el QT o interfieren con su metabolismo. La FDA mantiene una postura más restrictiva y advierte de prolongación del QT, torsade de pointes, parada cardiaca y muerte súbita, además de posibles efectos neuropsiquiátricos tras la retirada brusca, sobre todo con dosis altas.

Por ello, la formulación más actual sería esta: la domperidona puede considerarse, de manera individualizada y fuera de indicación en muchos contextos, cuando ya se han optimizado las medidas no farmacológicas y persiste una producción insuficiente, especialmente en madres de prematuros que dependen de la extracción. En Reino Unido, SPS 2024 la considera el fármaco de elección si realmente se precisa tratamiento farmacológico y propone 10 mg cada 8 horas, inicialmente durante 7 días y después revisión.

Sulpirida

La sulpirida aumenta la prolactina y se ha usado como galactogogo en algunos países, pero su valor clínico actual es cuestionable. Si se optimiza la técnica y la frecuencia de lactancia, es poco probable que aporte un beneficio adicional importante, y que no se ha estudiado adecuadamente su utilidad en mujeres que siguen con producción insuficiente tras corregir esos factores.

Además, la sulpirida pasa a la leche en cantidades relativamente altas en comparación con otros galactogogos, en algunos casos por encima del umbral clásico del 10% de la dosis materna ajustada por peso, y sus efectos en sangre del lactante no se han evaluado bien. También debe evitarse en mujeres con antecedente de depresión mayor y no prolongarse innecesariamente, porque puede empeorar el estado de ánimo, además de producir cansancio, cefalea o edema.

Por todo ello, hoy no la presentaría como una opción preferente. Si se menciona, debería hacerse como fármaco históricamente utilizado, con evidencia limitada y un perfil menos favorable que el de la domperidona

Otros fármacos

Otros fármacos que se utilizaron en el pasado como galactogogos —como clorpromazina, hormona de crecimiento, hormona liberadora de tirotropina u oxitocina nasal— han quedado relegados por la escasez de evidencia o por consideraciones de seguridad y tolerabilidad. La actualización de ABM no recomienda actualmente ningún galactogogo específico de forma general.

6.3 INDICACIONES DE PRESCRIPCIÓN DE GALACTOGOGOS

Los galactogogos solo deberían valorarse cuando, tras anamnesis y exploración adecuadas, se ha comprobado que existen condiciones que justifican su uso como coadyuvantes y que ya se han corregido o abordado los factores modificables.

Las situaciones clásicas en las que puede plantearse su uso siguen siendo razonables:

1. Separación forzosa madre-lactante por:

a. Hospitalización de la madre por enfermedad grave

b. Hospitalización del lactante por enfermedad grave

c. Prematuros ingresados. A las dos o tres semanas de extracciones sin demasiado o nulo contacto con sus bebés, disminuye la producción de leche.

2. Relactación tiempo después de un destete
3. Inducción de lactancia sin embarazo previo o actual (adopción en parejas heterosexuales, lesbianas y personas transgénero).

Cuando se opte por un galactogogo farmacológico, conviene informar de forma explícita a la madre sobre la incertidumbre real de la evidencia, los posibles efectos adversos, las contraindicaciones, las interacciones y la necesidad de seguimiento. En el caso de domperidona, debe revisarse de forma sistemática el riesgo cardiaco, los antecedentes de arritmia y los medicamentos concomitantes que prolongan el QT; algunas guías sugieren valorar un ECG, no un EEG, en situaciones de mayor riesgo (Brodribb 2018; FDA 2023).

6.4 CONCLUSIONES

Los galactogogos se utilizan desde hace siglos, pero la evidencia científica que respalda su uso sigue siendo, en conjunto, limitada y heterogénea. La mayoría de los productos herbales y farmacológicos no han demostrado de forma sólida mejorar desenlaces clínicamente relevantes a largo plazo, como la duración de la lactancia o la reducción del abandono.

La domperidona es el fármaco con mejor respaldo relativo, pero su beneficio parece concentrarse sobre todo en madres de prematuros y debe ponderarse frente a su perfil de riesgo cardiaco y a las diferencias regulatorias entre países. La metoclopramida no ha demostrado un beneficio consistente sobre el volumen de leche y presenta más limitaciones de seguridad, por lo que no debería recomendarse de rutina. La sulpirida dispone de evidencia antigua y limitada, pasa en mayor cantidad a la leche y tampoco debe considerarse una opción preferente.

Entre los galactogogos herbales, el fenogreco sigue siendo el más popular, pero no el más firmemente demostrado. Su posible efecto es, como mucho, modesto y su seguridad no está completamente establecida. Otras plantas, como el cardo mariano o la galega, cuentan con datos aún más limitados y no deben presentarse como soluciones claramente eficaces.

En la práctica, el mensaje más importante del tema debe seguir siendo este: ningún galactogogo sustituye a una valoración adecuada de la lactancia ni a un vaciamiento frecuente y eficaz del pecho. Su uso, cuando se considere, debe ser individualizado, prudente, temporal y siempre con supervisión sanitaria.

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