Dopamine is known to suppress lactation and dopamine agonist medications also have this effect. Although they are primarily used for Parkinson’s disease and restless leg syndrome, some of them have been used for lactation suppression, either postpartum or in women with prolactin-secreting tumors. Dopamine agonists should generally be avoided in lactating people who wish to continue breastfeeding due to their negative impact on milk production.^1,2 Due to the risks to milk production, lactating individuals should be engaged in shared decision making regarding the use of dopamine agonists. There is no absolute indication to pump and dump.

For more detailed information and references on specific medications, please refer to LactMed, e-lactancia, Infant Risk, or Mother to Baby.

Cabergoline, a non-ergot drug, has historically been used as an alternative for lactation suppression in women with HIV infection and to assist in weaning. It appears to be safer than bromocriptine. Cabergoline has been used in low doses to decrease overproduction of milk and for amenorrhea-galactorrhea syndrome or prolactinoma during lactation. Cabergoline is also used for medical cessation of lactation after stillbirths or with the need for abrupt weaning such as prior to cancer treatments.

Recent systematic reviews have found that cabergoline was effective, generally well-tolerated, and had a better safety profile than bromocriptine for lactation suppression. The adverse events ranged from 0-35% in the studies that were reviewed. While rare serious side effects do occur, the most common adverse events were mild, transient, and self-resolving (such as dizziness, headache, nausea and vomiting).^3,4 There is no data on milk transfer, but no adverse events have been reported in breastfed infants per e-lactancia and Infant Risk.

Due to the risks to milk production, lactating individuals should be engaged in shared decision making regarding the use of dopamine agonists. There is no absolute indication to pump and dump.

The indication for bromocriptine of lactation suppression has been withdrawn in the U.S. and discouraged in other countries because it increases the risk of maternal stroke, seizures, cardiovascular disorders, death and possibly psychosis. Bromocriptine has also been used in low doses during lactation to decrease overproduction of milk, for amenorrhea-galactorrhea syndrome, or prolactinoma during lactation. Alternatives are preferred due to the side effect profile and risks to the lactating parent.

Lisuride is used in some countries for lactation suppression and is thought to be a safer alternative to bromocriptine. Rebound lactation appears to be more common with lisuride than bromocriptine. This medication is not approved in the United States. Due to the risks to milk production, lactating individuals should be engaged in shared decision making regarding the use of lisuride.

Other commonly used dopamine agonists include apomorphine/Apokyn, , pramipexole/Mirapex, ropinirole/Requip, and rotigotine/Neupro and are used in the management of Parkinson’s disease and/or restless leg syndrome (RLS). These drugs have not been well studied in lactation. Due to the risks to milk production, lactating individuals should be engaged in shared decision making regarding the use of dopamine agonists.

With regards to RLS, many alternative management options are available and dopamine agonists can likely be avoided. Options to consider include massage, moderate-intensity exercise, yoga, sequential compression devices, treatment of obstructive sleep apnea (OSA), iron repletion, gabapentin, low-dose clonazepam, and opioids/tramadol.⁵ For more information, see the articles on Pain Medications and the section on Benzodiazepines in the article on Antiseizure medications.

No information is available for the use of this drug during lactation. This medication is known to suppress prolactin and may interfere with milk production. Due to the risks to milk production, and alternative is preferred and lactating individuals should be engaged in shared decision making regarding the use of dopamine agonists.

No information is available for the use of this drug during lactation. This medication is known to suppress prolactin and may interfere with milk production. Due to the risks to milk production, and alternative is preferred and lactating individuals should be engaged in shared decision making regarding the use of dopamine agonists.

No information is available for the use of this drug during lactation. This medication is known to suppress prolactin and may interfere with milk production. Due to the risks to milk production, and alternative is preferred and lactating individuals should be engaged in shared decision making regarding the use of dopamine agonists.

No information is available for the use of this drug during lactation. This medication is known to suppress prolactin and may interfere with milk production. Due to the risks to milk production, and alternative is preferred and lactating individuals should be engaged in shared decision making regarding the use of dopamine agonists.