Cabergoline Dose for Lactation Suppression
For postpartum lactation suppression, administer cabergoline 1 mg as a single oral dose within 24 hours of delivery, which achieves complete lactation inhibition in 78-92% of women. 1, 2
Standard Dosing Protocol
Single-dose regimen (preferred):
- 1 mg orally as a single dose within 24 hours postpartum 1, 2
- This achieves lactation suppression in 92% of cases with a single administration 2
- Time to cessation occurs between 0-1 days 1
- Prolactin levels remain suppressed at 14 days (mean 18.2 ng/ml) 2
Alternative divided-dose regimen:
- 0.25 mg twice daily for 2 days (total 1 mg) 1, 2, 3
- This regimen is effective for both primary lactation inhibition and secondary suppression of established lactation 2
- Approximately 85% effective for suppressing established puerperal lactation 4
Efficacy Compared to Alternatives
Cabergoline demonstrates superior efficacy and tolerability compared to other options:
- More effective than bromocriptine with significantly fewer rebound symptoms in the third postpartum week 4, 5
- Superior to pyridoxine (vitamin B6) for lactation inhibition (78% vs 35% success at day 7) 3
- Cabergoline reduces milk leakage more effectively than pyridoxine (9% vs 42% at day 7) 3
Adverse Effects Profile
Common self-limited effects (31% incidence): 3
- Dizziness, headache, and nausea are most frequently reported 1
- All adverse effects are typically mild and transient 1, 3
- Only 4% of patients require symptomatic treatment for moderate-intensity effects 2
- Better tolerated than bromocriptine (52% vs 72% adverse event rate) 5
Clinical Considerations and Contraindications
Absolute contraindications to cabergoline: 3
- Hypertensive disorders (including preeclampsia)
- Fibrotic diseases (cardiac, pulmonary, or retroperitoneal)
- Cardiac valvular disease
- Hepatic disease
For patients with contraindications:
- Consider pyridoxine 200 mg three times daily for 7 days as an alternative, though it has lower efficacy (35% success rate vs 78% with cabergoline) 3
Management of Treatment Failure
If initial 1 mg dose fails (8% of cases): 2
- Administer a second treatment cycle of cabergoline
- Approximately 21% of patients initially treated with pyridoxine will require switching to or adding cabergoline 3
Important Clinical Pitfalls
- Do not use cabergoline during pregnancy or for women planning to breastfeed, as it is contraindicated in these situations 6
- Unlike bromocriptine, cabergoline has not been associated with serious thromboembolic events in postpartum use, though experience is more limited 4
- The teratogenic potential has not been extensively studied (10 congenital abnormalities reported in 199 pregnancies), so it should not be first-line for hyperprolactinemia-related infertility 4