In the majority of cases, this is achieved by not stimulating the breasts (no suckling), using a firm supportive brassiere and analgesia if required. Breast discomfort usually improves in 5-6 days.
Complete suppression of lactation may be achieved by the use of drugs which inhibit the release of prolactin from the pituitary.
Cabergoline is simple, effective and generally safe when given to postpartum women either wishing or needing to suppress lactation (1). Bromocriptine should not be routinely used for stopping breast milk production (2).
Expert advice should be sought before use of medication in suppression of lactation.
Note:
Restrictions in use of bromocriptine for stopping breast milk production
European Medicine Agency (EMA) guidance states that the medicine should not be used routinely for preventing or stopping milk production after childbirth (2)
- on 20 August 2014, the Coordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh)1 endorsed by majority recommendations on the use of bromocriptine-containing medicines by mouth to prevent or suppress breast milk production (lactation) after childbirth
- the CMDh agreed that the medicines should only be used for this purpose (in strengths up to 2.5 mg) when there are compelling medical reasons for stopping lactation, such as the need to avoid further distress after loss of the baby during or just after childbirth, or in mothers with HIV infection, who should not breastfeed
- bromocriptine should not be used routinely for preventing or stopping milk production, and must not be used in women at increased risk of serious side effects, including women with various disorders that increase blood pressure or who have or have had heart disease or severe psychiatric disorders. Blood pressure should be monitored so that early signs of an increase can be detected and treatment stopped immediately
- the CMDh position followed a review by the EMA's Pharmacovigilance Risk Assessment Committee (PRAC) of available data on the safety and effectiveness of bromocriptine in controlling breast milk production after childbirth, which led to these recommendations. The review was triggered by concerns in France over increased reports of rare but potentially serious or fatal side effects, particularly cardiovascular side effects (such as heart attack and stroke), neurological side effects such as seizures (fits) and psychiatric side effects (such as hallucinations and manic episodes). Since lactation is a natural process that eventually stops if the infant is not breastfed, and other means of management are available, the French medicines agency (ANSM) asked the EMA to review the medicines and see if the benefits of such use still outweighed the risks.
As the CMDh position on bromocriptine was adopted by majority vote, it was sent to the European Commission, which took an EU-wide legally binding decision on 30 October 2014.
The summary of product characteristics should be consulted before prescribing the drugs described
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