What about using cabergoline (dopamine receptor agonist) as a galactagogue?

Cabergoline as a Galactagogue: Not Recommended

Cabergoline should not be used as a galactagogue because it is a potent dopamine agonist that suppresses prolactin secretion and inhibits lactation—the exact opposite of what is needed to increase milk supply. 1, 2

Mechanism of Action

Cabergoline works by:

• Acting as a long-acting dopamine D2 receptor agonist with high affinity and specificity 1, 2
• Directly inhibiting prolactin secretion by pituitary lactotrophs 1
• Suppressing physiological lactation when given as a single 1 mg oral dose after delivery 3

Clinical Evidence for Lactation Suppression

The drug is specifically used to inhibit lactation, not promote it:

• A single 1 mg dose achieves complete lactation inhibition in 90.2% of postpartum women by day 14 4
• Success rates for lactation suppression range from 78-100% 3
• It is more effective than bromocriptine for preventing puerperal lactation with significantly lower rebound lactation rates 2
• The prolactin-lowering effect is rapid and can last up to 21 days after a single dose 2

Appropriate Galactagogues

For women needing to increase milk supply, the evidence supports different agents:

• Metoclopramide remains the galactagogue of choice due to documented efficacy and safety, working through dopamine receptor antagonism to increase prolactin levels 5
• Domperidone is used as a galactagogue with lower blood-brain barrier penetration and breast milk transfer than metoclopramide, also increasing milk supply 6, 5

Critical Distinction

The fundamental pharmacologic difference is:

• Galactagogues work by blocking dopamine receptors → increased prolactin → increased milk production 5
• Cabergoline works by activating dopamine receptors → decreased prolactin → suppressed lactation 1, 2

Clinical Applications of Cabergoline

Cabergoline is appropriately used for:

• Hyperprolactinemia treatment (normalizes prolactin in 83% of patients at 0.5 mg twice weekly) 7, 8
• Prevention of postpartum lactation in women who choose not to breastfeed, including women living with HIV 3
• Suppression of established puerperal lactation (85% effective at 0.25 mg twice daily for 2 days) 2

Using cabergoline when attempting to establish or maintain lactation would be counterproductive and potentially harmful to breastfeeding goals.