Medication for Stopping Breast Milk Production
Cabergoline is the drug of choice for stopping breast milk production, administered as a single 1 mg oral dose within 24-27 hours after delivery for prevention of lactation, or 0.25 mg twice daily for 2 days for suppression of established lactation. 1, 2, 3
Mechanism and Efficacy
Cabergoline is a synthetic ergoline derivative with high specificity and affinity for dopamine D2 receptors, making it a potent and long-acting inhibitor of prolactin secretion. Its effectiveness in stopping lactation includes:
- Complete success rate of 78-100% in preventing lactation 2, 3
- Single dose administration provides prolonged effect (up to 21 days) 2
- Significantly lower incidence of rebound lactation compared to alternatives 3
- For established lactation suppression, dosing is 0.25 mg twice daily for 2 days 2
Dosage Regimens
For Prevention of Lactation (before milk comes in):
- Single oral dose of 1 mg administered within 24-27 hours after delivery 3, 4
- No additional doses required in most cases
For Suppression of Established Lactation:
- 0.25 mg twice daily for 2 days (total dose 1 mg) 2
- Effective in approximately 85% of women
Advantages Over Alternative Medications
Cabergoline offers significant advantages over bromocriptine (previously used for lactation suppression):
- Single dose administration versus 14 days of twice-daily dosing 3
- Better tolerability profile with fewer adverse effects 2, 3
- Lower rate of rebound breast symptoms (3.7% vs 17% with bromocriptine) 3
- Effective even after cesarean delivery 5
Safety Considerations
- Most common side effects include nausea, dizziness, and headache, but these are typically mild and transient 2, 3
- Contraindicated in women with hypersensitivity to ergot derivatives 1
- Not recommended for women who plan to breastfeed as it interferes with lactation 1
- Should not be used in women with uncontrolled hypertension or history of pulmonary, pericardial, or retroperitoneal fibrotic disorders
Special Populations
- Cabergoline has been studied and found effective in women living with HIV who choose not to breastfeed 6
- Limited data available regarding use in elderly patients, so caution is advised 1
- Safety in pediatric patients has not been established 1
Clinical Pearls
- Maximum decrease in serum prolactin occurs approximately 5 days after administration 5
- The prolactin-lowering effect persists for up to 2-3 weeks after a single dose 2
- If lactation symptoms persist after initial treatment, an additional dose may be considered, but this is rarely necessary
- Non-pharmacological measures like breast binding and ice packs may provide additional comfort
Cabergoline's simple administration schedule, high efficacy rate, and favorable side effect profile make it the optimal choice for lactation inhibition when medically indicated.