Medications to Dry Up Breast Milk
Cabergoline is the most effective medication for drying up breast milk, with a single 1 mg dose providing superior efficacy and fewer side effects compared to alternatives. 1, 2
First-Line Treatment: Cabergoline
- Cabergoline is a synthetic ergoline with high specificity for dopamine D2 receptors, making it a potent and long-acting inhibitor of prolactin secretion 1
- A single dose of cabergoline 1 mg is as effective as bromocriptine 2.5 mg twice daily for 14 days in preventing lactation 2
- Cabergoline has a significantly lower incidence of rebound lactation compared to bromocriptine (3.1% vs 11.7%) 3, 2
- For established lactation suppression, cabergoline 0.25 mg twice daily for 2 days is effective in approximately 85% of women 1
Mechanism and Efficacy
- Cabergoline works by inhibiting prolactin secretion, which is essential for milk production 1
- The prolactin-lowering effects occur rapidly and can last up to 21 days after a single dose in postpartum women 1
- Studies show cabergoline effectively reduces udder engorgement and milk leakages 3
- Complete success in preventing lactation was achieved in 106 of 136 women with a single 1 mg dose of cabergoline 2
Safety Profile
- Cabergoline is better tolerated than bromocriptine in postpartum women 1, 4
- Common side effects include dizziness, headache, and nausea, but these are generally self-limited 5
- Most patients who are intolerant of other ergot derivatives can tolerate cabergoline 1
- Unlike bromocriptine, cabergoline has not been associated with serious thromboembolic events in the puerperium 1
Important Considerations and Contraindications
- Cabergoline should not be given to women who are planning to breastfeed due to its interference with lactation 6
- The FDA label indicates cabergoline is not recommended for the inhibition or suppression of physiologic lactation, though this is an off-label use widely supported by research 6, 5
- Caution should be exercised in women with hepatic impairment, as cabergoline is extensively metabolized in the liver 6
- The drug should be avoided in women with uncontrolled hypertension or history of pulmonary, pericardial, or retroperitoneal fibrotic disorders 6
Dosing Recommendations
- For prevention of lactation: Single 1 mg dose within 24 hours after delivery 2
- For suppression of established lactation: 0.25 mg twice daily for 2 days 1
- Administration with food may help reduce gastrointestinal side effects 4
Alternative Options
- If cabergoline is contraindicated or unavailable, bromocriptine can be used at 2.5 mg twice daily for 14 days, though it has more side effects and requires a longer treatment course 1, 2
- Non-pharmacological methods (tight breast binding, ice packs, avoiding breast stimulation) can be used as adjuncts but are less effective than pharmacological approaches 5