What medication can be prescribed to stop lactation?

Cabergoline for Lactation Suppression

Cabergoline 1 mg as a single oral dose is the medication of choice for stopping lactation in postpartum women, offering superior efficacy and tolerability compared to alternatives like bromocriptine. 1, 2

Dosing Regimen

Single-dose regimen (preferred):

• Administer cabergoline 1 mg orally as a single dose within 24 hours of delivery for primary lactation inhibition 3, 4
• This achieves complete lactation suppression in 92-95% of women 3, 4
• Time to cessation occurs within 0-1 day 2

Two-day regimen (for established lactation):

• For women who have already begun lactating, use cabergoline 0.25 mg twice daily for 2 days 3
• This secondary inhibition approach suppresses established lactation in approximately 85% of cases 5

Dose-response considerations:

• The 0.5 mg dose shows only 65% efficacy, making it inadequate for reliable lactation suppression 4
• The 1 mg dose demonstrates significantly superior effectiveness (95% vs 65%, p<0.001) 4

Mechanism and Pharmacology

Cabergoline is a long-acting dopamine D2 receptor agonist that potently inhibits prolactin secretion 5, 6:

• Prolactin-lowering effects persist for up to 21 days after a single dose in puerperal women 5
• Mean serum prolactin levels drop to 12.5 ng/ml at 4 days and 18.2 ng/ml at 14 days post-administration 3

Safety Profile

Common adverse effects (generally mild and self-limited): 2

• Dizziness, headache, and nausea occur in 25-32.5% of patients 3, 4
• Only 4% require symptomatic treatment for moderate-intensity side effects 3

Critical safety advantage over bromocriptine:

• Significantly lower incidence of rebound lactation in the third postpartum week 5, 2
• Better overall tolerability, particularly regarding nausea and vomiting 6
• No reports of thromboembolic events associated with cabergoline, unlike bromocriptine 5

Important Contraindications and Warnings

Do not use cabergoline in women who plan to breastfeed: 1

• The FDA label explicitly states cabergoline interferes with lactation and should not be given to women postpartum who are breastfeeding or planning to breastfeed 1
• The prolactin-lowering action directly prevents milk production 1

Pregnancy considerations:

• Cabergoline should be used during pregnancy only if clearly needed, as animal studies showed maternotoxicity and embryofetal losses 1
• Limited human data exists: 10 congenital abnormalities reported in 199 cabergoline-associated pregnancies, though no consistent pattern emerged 5

Clinical Algorithm for Use

Step 1 - Verify indication:

• Confirm the woman has a valid medical or personal reason for lactation suppression
• Ensure she is not planning to breastfeed 1

Step 2 - Timing of administration:

• For primary inhibition: Give within 24 hours of delivery 3
• For secondary suppression: Can be given after lactation has begun 3

Step 3 - Select appropriate regimen:

• Use 1 mg single dose for primary inhibition (92-95% success rate) 3, 4
• Use 0.25 mg twice daily for 2 days for established lactation (85% success rate) 5

Step 4 - Monitor for effectiveness:

• Assess at 4 days and 14 days post-administration 3
• If lactation persists (8% of cases), a second treatment cycle may be required 3

Step 5 - Manage adverse effects:

• Most side effects are self-limited and require no intervention 2
• Provide symptomatic treatment only if moderate-intensity effects occur (4% of cases) 3

Common Pitfalls to Avoid

• Do not use the 0.5 mg dose - it has inadequate efficacy (only 65% success) compared to 1 mg 4
• Do not prescribe bromocriptine instead - it requires 14 days of twice-daily dosing, has higher rebound rates, and worse tolerability 5, 2
• Do not give to breastfeeding mothers - cabergoline will interfere with established lactation that the mother wishes to continue 1