What is the best medication to suppress lactation?

From the Guidelines

The best medication to suppress lactation is bromocriptine, as it is effective in inhibiting prolactin and has been used in clinical settings for this purpose, although its primary use is in the treatment of peripartum cardiomyopathy and other conditions 1. When considering the suppression of lactation, it's crucial to weigh the benefits and risks of each medication option.

• Bromocriptine has been studied in the context of peripartum cardiomyopathy and has shown promise in improving left ventricular ejection fraction (LVEF) recovery and reducing mortality in this patient population 1.
• However, its use for lactation suppression must be considered with caution, especially given its potential side effects and the need for careful patient selection.
• The European Society of Cardiology endorses a treatment approach that includes bromocriptine for acute peripartum cardiomyopathy management, highlighting its potential benefits in specific clinical contexts 1.
• It's also important to consider non-pharmacological methods to support lactation suppression, such as avoiding breast stimulation and applying cold compresses.
• Ultimately, the decision to use bromocriptine or any other medication for lactation suppression should be made in consultation with a healthcare provider, taking into account the individual patient's medical history, current health status, and specific needs.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Bromocriptine mesylate is a dopamine receptor agonist, which activates post-synaptic dopamine receptors The dopaminergic neurons in the tuberoinfundibular process modulate the secretion of prolactin from the anterior pituitary by secreting a prolactin inhibitory factor (thought to be dopamine); in the corpus striatum the dopaminergic neurons are involved in the control of motor function Clinically, bromocriptine mesylate significantly reduces plasma levels of prolactin in patients with physiologically elevated prolactin as well as in patients with hyperprolactinemia. The inhibition of physiological lactation as well as galactorrhea in pathological hyperprolactinemic states is obtained at dose levels that do not affect secretion of other tropic hormones from the anterior pituitary

The best medication to suppress lactation is bromocriptine, as it significantly reduces plasma levels of prolactin, which is the hormone responsible for milk production. Bromocriptine is a dopamine receptor agonist that inhibits the secretion of prolactin from the anterior pituitary, thereby suppressing lactation 2.

• Key benefits:
  • Reduces plasma levels of prolactin
  • Inhibits physiological lactation
  • Does not affect secretion of other tropic hormones from the anterior pituitary
• Important consideration: Bromocriptine should be taken with food to minimize the risk of vomiting.

From the Research

Medications for Suppressing Lactation

• Cabergoline is a potent and long-acting inhibitor of prolactin secretion, which can effectively suppress lactation 3.
• A single dose of cabergoline 1.0mg is as effective as bromocriptine 2.5mg twice daily for 14 days in preventing puerperal lactation, with a significantly lower incidence of rebound lactation 4.
• Cabergoline has been shown to be superior to pyridoxine (vitamin B6) in inhibiting lactation, with a success rate of 78% compared to 35% for pyridoxine 5.
• A single oral dose of 1mg cabergoline is as effective in suppressing puerperal lactation as a full treatment with bromocriptine, even in women delivered by cesarean section 6.
• The smallest effective dose of cabergoline for lactation inhibition is 1.0mg, with a satisfactory clinical effectiveness of 95% and adverse effects in 25% of patients 7.

Comparison of Medications

• Cabergoline is better tolerated than bromocriptine, with fewer adverse effects and a lower risk of serious thromboembolic events 3.
• Pyridoxine (vitamin B6) may be considered as an alternative to cabergoline for women with contraindications to cabergoline, although it is less effective in inhibiting lactation 5.
• Bromocriptine is associated with a higher risk of lactation rebound and adverse effects compared to cabergoline 3, 4.

Adverse Effects

• Common adverse effects of cabergoline include nausea, vomiting, headache, and dizziness 3.
• Cabergoline has a lower incidence of adverse effects compared to bromocriptine, although it is not entirely free of adverse effects 3, 4.
• Pyridoxine (vitamin B6) has been shown to have no significant adverse effects in inhibiting lactation 5.