Cabergoline Dosage for Lactation Suppression
The recommended dosage of cabergoline for lactation suppression is 0.25 mg twice daily (every 12 hours) for a total of 2 doses (1 mg total). This regimen is effective in suppressing established puerperal lactation in approximately 85% of women 1.
Dosing Regimens for Different Scenarios
For Established Lactation Suppression
- Standard regimen: 0.25 mg twice daily for 2 days (total 1 mg)
- Administration should be timed approximately 12 hours apart
- This regimen is effective in about 85% of women 1
For Prevention of Lactation (Before Milk Production Begins)
- Single dose regimen: 1 mg as a one-time dose within 24 hours after delivery
- This approach is as effective as bromocriptine 2.5 mg twice daily for 14 days 1, 2
- Shows significantly lower incidence of rebound lactation in the third postpartum week compared to bromocriptine 1
Efficacy and Advantages
Cabergoline offers several advantages for lactation suppression:
- Long-acting inhibitor of prolactin secretion with effects lasting up to 14-21 days after a single dose 1
- Higher efficacy rate (95%) with the 1 mg dose compared to 0.5 mg dose (65%) 2
- Better tolerated than bromocriptine with fewer adverse effects 3
- Lower rate of rebound lactation compared to other agents 1, 4
Monitoring and Side Effects
Common Side Effects
- Nausea, vomiting, headache, and dizziness are characteristic adverse events 1
- Side effects occur in approximately 25-32.5% of patients but are generally mild 2
- Side effects can be minimized by:
- Starting with a low dose
- Taking the medication with food
- Taking the medication while lying down
Serious Considerations
- Unlike bromocriptine, cabergoline has not been associated with serious thromboembolic events in the puerperium 1
- For patients requiring long-term therapy (not typical for lactation suppression), cardiac monitoring may be necessary 5
Clinical Pearls
- Cabergoline is considered the drug treatment of first choice for lactation suppression due to its superior efficacy and tolerability profile 1, 6
- The single 1 mg dose or divided 0.25 mg twice daily for 2 days regimens are both effective, with the divided dose potentially minimizing adverse events 6
- In cases where the initial regimen is insufficient (approximately 8% of cases), a second treatment cycle may be required 4
- Prolactin levels typically decrease to approximately 12.5 ng/ml by day 4 and remain low (around 18.2 ng/ml) through day 14 after administration 4
Cabergoline's long-acting dopaminergic properties make it particularly well-suited for lactation suppression with minimal dosing requirements and better tolerability compared to older agents like bromocriptine.