Cabergoline for Lactation Suppression
Cabergoline is highly effective for stopping milk production and should be used at a dose of 1 mg orally as a single dose within 24 hours of delivery, or alternatively as 0.25 mg twice daily for 2 days to minimize side effects. 1, 2, 3
Efficacy and Dosing
A single 1 mg oral dose of cabergoline achieves complete lactation inhibition in 78-92% of postpartum women, with superior efficacy compared to bromocriptine and fewer rebound symptoms. 2, 4, 5
The alternative dosing regimen of 0.25 mg twice daily for 2 days is equally effective and may reduce the incidence of side effects, though a single 1 mg dose remains the standard approach. 1, 2, 3
Lower doses (0.5 mg) show reduced efficacy at only 65% success rate, making them suboptimal for lactation inhibition. 6
If lactation is not fully suppressed after the initial dose, a second treatment cycle may be required in approximately 8% of cases. 2
Mechanism and Timing
Cabergoline works as a long-acting dopamine agonist that inhibits prolactin secretion, thereby preventing milk production and reducing breast engorgement. 3, 5
The medication should be administered within 24 hours of delivery for primary lactation inhibition, or can be used for secondary suppression of established lactation using the 0.25 mg twice daily for 2 days regimen. 2, 3
Time to complete cessation of lactation ranges from 0-1 day with the 1 mg dose. 5
Safety Profile and Side Effects
Common adverse effects include dizziness, headache, and nausea, occurring in approximately 25-31% of patients, but these are typically mild and self-limited. 4, 5
In clinical trials, only 4% of patients required symptomatic treatment for moderate-intensity side effects. 2
The FDA label specifically warns that cabergoline interferes with lactation and should not be given to women who are breastfeeding or planning to breastfeed. 1
Important Contraindications and Precautions
Cabergoline is contraindicated in patients with hypertensive disorders, fibrotic diseases, cardiac valvulopathy, or hepatic impairment. 1, 4
The FDA has issued warnings against using cabergoline for routine postpartum lactation suppression due to historical concerns with dopamine agonists (particularly bromocriptine) being associated with hypertension, stroke, and seizures in the postpartum period. 1
Initial doses higher than 1 mg may produce orthostatic hypotension, requiring careful monitoring. 1
Cabergoline can cause impulse control disorders including pathological gambling, hypersexuality, and compulsive behaviors, which are generally reversible upon dose reduction or discontinuation. 1
Alternative for High-Risk Patients
For women with contraindications to cabergoline, pyridoxine (vitamin B6) at 200 mg three times daily for 7 days can be considered, though it has lower efficacy (35% complete success vs 78% with cabergoline) and higher rates of milk leakage. 4
Pyridoxine has minimal adverse effects and may be appropriate for patients with hypertensive disorders or other contraindications to dopamine agonists. 4
Clinical Outcomes
Cabergoline reduces serum prolactin levels to approximately 12.5 ng/mL at 4 days and 18.2 ng/mL at 14 days post-administration. 2
The incidence of milk leakage at day 7 is significantly lower with cabergoline (9%) compared to alternative treatments like pyridoxine (42%). 4
Rates of mastitis and fever related to breast engorgement are similar between cabergoline and alternative treatments (approximately 5-9%). 4