What is the recommended dosage and frequency of cabergoline (dopamine receptor agonist) for lactation inhibition in adult females?

Cabergoline Dosage for Lactation Inhibition in Adult Females

For lactation inhibition in adult females, a single oral dose of 1 mg cabergoline is recommended, which can be administered either as a single dose or divided as 0.25 mg twice daily for 2 days to minimize side effects. 1, 2

Dosing Regimens

• Single dose administration: 1 mg cabergoline as a single oral dose within 24-27 hours after delivery 2
• Divided dose administration: 0.25 mg twice daily for 2 days (total 1 mg) to minimize adverse events while maintaining efficacy 1, 3

Efficacy

• Cabergoline successfully inhibits lactation in approximately 78-94% of women 1, 4
• The prolactin-lowering effect begins rapidly and persists for up to 14-21 days after a single dose 5, 2
• Cabergoline demonstrates superior efficacy compared to alternative treatments:
  • More effective than pyridoxine (78% vs 35% success rate at day 7) 1
  • At least as effective as bromocriptine with significantly lower rates of rebound breast activity 2

Advantages Over Other Treatments

• Simpler administration: Single dose vs. bromocriptine's 14-day regimen 2
• Longer duration of action: Prolactin-lowering effects persist for up to 21 days 5
• Lower rebound rate: Significantly fewer cases of rebound breast symptoms compared to bromocriptine (3.7% vs 16.9%) 2
• Better tolerability: Although side effects occur in about 31% of patients, they are generally mild 1

Side Effects and Monitoring

• Common side effects include nausea, vomiting, headache, and dizziness 5
• While cabergoline has more adverse effects than pyridoxine (31% vs 9%), these are typically mild and well-tolerated 1
• Caution should be exercised in patients with hypertensive disorders, fibrotic, cardiac, or hepatic diseases, as cabergoline may be contraindicated in these conditions 1

Clinical Considerations

• Cabergoline is considered the drug of choice for lactation inhibition due to its efficacy, convenience, and tolerability profile 5, 2
• For women with contraindications to cabergoline, pyridoxine (200 mg three times daily for 7 days) may be considered as an alternative, though it has lower efficacy 1
• The timing of administration is important - cabergoline should be given within 27 hours after delivery for optimal results in preventing lactation 2

Special Populations

• Limited data exists on cabergoline's teratogenic potential in humans, with 10 congenital abnormalities reported in 199 cabergoline-associated pregnancies 5
• Due to limited experience with cabergoline in pregnancy, it should not be considered first-line therapy for treating infertility associated with hyperprolactinemia 5