What medication can be used to stop breastfeeding?

Medications to Stop Breastfeeding

Cabergoline is the medication of choice for inhibiting lactation, administered as a single 1 mg oral dose within 27 hours after delivery. 1, 2, 3

First-Line Option: Cabergoline

• Cabergoline is a dopaminergic agonist that effectively inhibits prolactin secretion and suppresses physiologic lactation 1
• A single 1 mg oral dose of cabergoline has shown success rates between 78% and 100% for lactation inhibition 1
• Cabergoline offers significant advantages over alternatives due to its:
  • Single-dose administration (versus 14 days of twice-daily dosing for bromocriptine) 4
  • Lower rate of rebound breast symptoms (5% vs 23% with bromocriptine) 4
  • Better tolerability profile with fewer adverse events 2

Dosing and Administration

• Standard dosage: 1 mg as a single oral dose within 27 hours after delivery 4, 3
• For suppression of established lactation: 0.25 mg twice daily for 2 days (total dose 1 mg) 2
• Effectiveness is dose-dependent, with 1 mg showing the highest rate of complete success 3
• Time to cessation of lactation typically occurs between 0-1 day after administration 3

Safety Considerations

• Cabergoline is generally well-tolerated with transient, mild to moderate adverse effects 1
• Common side effects include dizziness, headache, and nausea, which are typically self-limited 3
• Caution should be exercised in women with:
  • Uncontrolled hypertension (14% of patients in one study had pre-existing hypertensive disorders) 5
  • History of cardiovascular or pulmonary disease 5

Important Contraindications

• Cabergoline should not be given to women who plan to breastfeed 6
• The FDA label specifically states: "Due to this interference with lactation, cabergoline should not be given to women postpartum who are breastfeeding or who are planning to breastfeed" 6
• Caution should be used in women with impaired hepatic or renal function 6

Clinical Considerations

• Cabergoline is particularly useful in situations where breastfeeding is contraindicated, such as:
  • Stillbirth (50.6% of cases in one study) 5
  • Abortion (27.1%) 5
  • Neonatal death (12.9%) 5
  • Maternal medical conditions requiring medications incompatible with breastfeeding 5
  • Women living with HIV in settings where breastfeeding is not recommended 1

Alternative Options

• If cabergoline is contraindicated, bromocriptine may be considered, though it:
  • Requires a longer treatment course (2.5 mg twice daily for 14 days) 4
  • Has higher rates of rebound breast symptoms 4
  • Is associated with more adverse events 2
  • Has been linked to increased risk of serious thromboembolic events in the postpartum period 2