Is cabergoline (dopamine receptor agonist) contraindicated in breastfeeding?

Cabergoline is Contraindicated During Breastfeeding

Cabergoline should not be given to women who are breastfeeding or planning to breastfeed as it interferes with lactation and is explicitly contraindicated during breastfeeding according to FDA labeling. 1

Mechanism and Contraindication

• Cabergoline is a dopamine receptor agonist that inhibits prolactin secretion, which directly interferes with milk production and lactation 1, 2
• The FDA drug label explicitly states: "Due to this interference with lactation, cabergoline should not be given to women postpartum who are breastfeeding or who are planning to breastfeed" 1
• The drug is specifically designed and used for lactation inhibition in situations where breastfeeding is not desired or contraindicated 3, 4

Clinical Evidence

• Cabergoline is highly effective at inhibiting lactation, with success rates between 78% and 100% when given as a single 1 mg oral dose after delivery 2, 5
• Studies show cabergoline is superior to alternative agents like pyridoxine for lactation inhibition (78% vs 35% success rate) 4
• While cabergoline is effective for lactation inhibition, this is precisely why it should not be used in women who wish to breastfeed 3, 2

Safety Concerns

• The drug's mechanism of action directly suppresses physiologic lactation, making it incompatible with successful breastfeeding 1, 2
• The FDA label clearly indicates that when a mother is taking cabergoline, a decision must be made to either discontinue breastfeeding or discontinue the drug 1
• All drugs are excreted into breast milk to some degree, and while specific data on cabergoline levels in breast milk is limited, its pharmacological action directly prevents milk production 6

Appropriate Use of Cabergoline

• Cabergoline is appropriately used for lactation inhibition in specific scenarios such as:
  • Stillbirth (50.6% of cases in one study) 3
  • Abortion (27.1% of cases) 3
  • Neonatal death (12.9% of cases) 3
  • Maternal medical conditions requiring medications incompatible with breastfeeding 3
  • Women living with HIV in developed countries where breastfeeding is not recommended 2

Clinical Implications

• For women who need to take cabergoline for conditions such as prolactinoma but wish to breastfeed, the medication should be discontinued, and alternative management strategies should be considered 1
• The benefits of breastfeeding are significant for both mother and infant, including protection against infectious diseases and reduced risk of certain cancers 7
• When a mother requires cabergoline therapy for medical reasons, the decision between continuing medication or breastfeeding should consider the importance of the drug to the mother versus the benefits of breastfeeding 1

Common Pitfalls

• Mistakenly prescribing cabergoline to women who intend to breastfeed, which will prevent successful lactation 1, 2
• Failing to recognize that cabergoline is specifically designed to inhibit lactation and is therefore incompatible with breastfeeding 1, 4
• Not providing appropriate counseling about the drug's effects on milk production before initiating therapy 3