Safety in Lactation: Bromocriptine and other dopaminergic drugs

Sarah Fenner, Acting Co-Director, Midlands and East Medicines Advice Service (Midlands site) & UK Drugs in Lactation Advisory ServicePublished

These dopaminergic drugs are used for the treatment of specific pituitary and prolactin-mediated disorders, including galactorrhoea, hyperprolactinaemia and prolactinomas. They are also used to suppress lactation by inhibiting prolactin secretion although symptoms of post-partum pain and engorgement can normally be adequately treated with simple analgesics and breast support. Bromocriptine is off-label (unlicensed) for routine lactation suppression and is not recommended as several cases of maternal seizures, stroke, psychiatric effects (including psychosis) and death have been reported when used for suppression of lactation. This is supported by a 2014 EMA recommendation.
Although cabergoline is the only drug licensed for routine suppression of lactation, and has not been associated with serious maternal adverse effects, its use is not usually recommended.  Small, incremental doses may reduce, but not completely suppress lactation, although this cannot be guaranteed.