What medication can be used to stop lactation or breastfeeding?

Medications for Stopping Lactation or Breastfeeding

Cabergoline is the preferred medication for inhibition of lactation with a single 1 mg dose providing effective suppression while having fewer adverse effects than alternatives like bromocriptine. 1, 2

First-Line Medication Option

Cabergoline

• Dosage: 1 mg as a single oral dose within 24 hours after delivery 2
• Mechanism: Dopamine agonist that inhibits prolactin secretion
• Effectiveness: High rate of complete success with time to cessation between 0-1 day 2
• Advantages:
  • Once-only dosing (compared to multiple doses for other medications)
  • Better tolerated than bromocriptine
  • Fewer rebound symptoms
  • Long-acting (elimination half-life allows for single dosing) 3

Safety Considerations

Side Effects of Cabergoline

• Common side effects (generally mild and self-limiting):
  • Dizziness
  • Headache
  • Nausea 2
• These side effects can be minimized by taking the medication with food or while lying down 3

Contraindications

• Caution in patients with:
  • Hepatic impairment (extensive liver metabolism) 1
  • History of psychiatric disorders (impulse control disorders reported) 1
• Should not be administered concurrently with D2-antagonists (phenothiazines, butyrophenones, thioxanthenes, metoclopramide) 1

Alternative Approaches

Non-Pharmacological Methods

• Simple analgesics: Paracetamol can ease discomfort associated with breast engorgement 4
• Supportive measures:
  • Wearing a supportive bra (preferable to breast binding which causes more discomfort) 4
  • Cold compresses to reduce inflammation and pain
• Without intervention, lactation naturally ceases after 1-2 weeks 4

Medications to Avoid

• Bromocriptine: Contraindicated due to potentially serious cardiovascular adverse effects that are disproportionate to the discomfort they prevent 4, 5
• High-dose estrogens: Unreasonable risk of thromboembolism in the postpartum setting 4
• Diuretics: No proven efficacy for lactation suppression 4

Clinical Decision Algorithm

1. Assess necessity: Determine if pharmacological suppression is truly needed (some women may tolerate the temporary discomfort with simple measures)
2. If pharmacological suppression is desired:
   • Verify no contraindications to cabergoline
   • Administer 1 mg oral dose of cabergoline within 24 hours after delivery
3. If cabergoline is contraindicated:
   • Rely on non-pharmacological measures (supportive bra, cold compresses)
   • Use paracetamol for pain management
4. Monitor for adverse effects:
   • Observe for dizziness, headache, nausea
   • Instruct patient to report any unusual symptoms

Important Caveats

• Medications should not be routinely given to women who do not wish to breastfeed without discussing risks and benefits 5
• Women should be informed that breast discomfort, while potentially intense, is temporary and typically resolves within 1-2 weeks 4
• The risks of pharmacological treatments should be carefully weighed against the temporary nature of lactation discomfort 4