This section reviews commonly used medications, herbs, supplements, and other substances that have theoretical or proven risks to decrease milk production. This section will focus on the effects on milk production. Many of these medications do not require pumping and dumping and are reviewed in more detail in other articles in the TPD app. Any time a lactating parent is taking substances that potentially decrease milk production, they should be counseled on the risk to milk production and infants should be closely monitored for appropriate growth.

This section is divided into two main subsections. The first section includes categories containing substances that may be prescribed for lactating parents with hyperlactation/oversupply or who require rapid weaning of breast milk production. The second section includes categories of substances that may impact milk production but are not typically used to intentionally suppress lactation.

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

Categories of medications and substances in this section include options to intentionally decrease milk production.

Pseudophedrine/Sudafed

Milk production is acutely decreased after use of pseudoephedrine, and with repeated use, can interfere with long term milk production. Pseudoephedrine has been used to suppress milk production in those with hyperlactation.¹ Due to the significant risk to milk production, pseudoephedrine should be avoided in those who want to maintain or increase production of milk. There is no absolute indication to pump and dump. For more information, see the section on Over the Counter Medications.

Several dopamine agonists are (or were previously) used in the suppression of lactation. For more information on Dopamine Agonists, please see the section on Dopamine Agonists.

Cabergoline

Cabergoline will suppress lactation by inhibiting prolactin secretion from the pituitary gland. While there are documented side effects, cabergoline is associated with less side effects than bromocriptine, and is preferred for lactation suppression over bromocriptine. Side effects include headache, dizziness, nausea, and vomiting.² The half-life of cabergoline is long, which means that side effects can last for longer periods of time. Short term, low-dose cabergoline (0.25 mg once with repeat dosage in 3 days if needed) is an option for high milk production unresponsive to other management options or when rapid lactation suppression is desired or indicated for medical reasons.³ There is no absolute indication to pump and dump.

Bromocriptine

Bromocriptine will suppress lactation by inhibiting prolactin secretion from the pituitary gland. An alternative medication should be sought out if a lactating person who is on bromocriptine desires to continue breastfeeding. Should lactation suppression be desired, bromocriptine is not recommended, due to serious side effects including stroke, seizure, psychosis, severe hypertension, and heart attack.⁴ Side effects are more common in patients with pre-existing conditions that increase the risk of adverse cardiovascular events such as tobacco use,  a history of hypertension or pre-eclampsia, or elevated body mass index (BMI).⁵ Due to the risk for side effects, alternative agents are preferred for lactation suppression. Due to the risks to milk production, alternative agents are preferred if bromocriptine is being used in the management of another condition.

Other Dopamine Agonists

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. For more information, see the section on Dopamine Agonists.

Many hormonal medications and agents can impact lactation. This article focuses on the milk production effects of these agents. For more detailed information on specific types of hormonal contraception, please see the article on Contraceptives.

Estrogen

It is well established that estrogen can frequently interfere with milk production and it can be used to manage hyperlactation.^6–8 Patients should be engaged in shared decision making with the use of estrogen containing medications during lactation and informed of the risks to milk production. While families should be counseled about the theoretical risk to milk production, there is no absolute indication to pump and dump.

Progesterone

Progesterone may decrease milk production, but it has less potential to do so  than estrogen. The World Health Organization recommends waiting until 6 weeks postpartum to use progesterone containing products, to avoid a decrease in milk production.⁸ While families should be counseled about the theoretical risk to milk production, there is no absolute indication to pump and dump. For more information about specific types of progesterone containing contraceptives (including Depo-Provera and long acting reversible contraception or LARCs) and recommendations for counseling during lactation, see the section on Contraceptives.

Testosterone

Testosterone, in high doses, can suppress milk production. Historically testosterone was used in high doses, or in combination with estrogen to suppress lactation postpartum but it is no longer used for this purpose.⁹ Currently, a transgender individual who is taking testosterone as gender affirming treatment may experience a decrease in milk production. Testosterone goes through a first stage of metabolization prior to entering milk. Therefore, testosterone exposure via breastmilk is minimal and infants are not adversely affected by a lactating parent’s use of oral or intramuscular testosterone.¹⁰ Topical use of testosterone warrants caution to ensure that the infant’s skin does not come in to contact with the topical testosterone product. Families should be counseled about the potential risk to milk production, but there is no absolute  indication to pump and dump.

Chasteberry

While Chasteberry has typically been used as a galactagogue¹¹, can cause lactation suppression at some doses. Therefore, chasteberry should be avoided to avoid the risk of decreased milk production.¹²

Peppermint

Peppermint is an herb which is a hybrid species of mint. It is widely used as a relaxant, and an anti-emetic. Traditionally, it has been used to decrease or suppress milk supply, although this has not been demonstrated in the literatur.¹³ There is no absolute indication to pump and dump.

Sage

Sage has been used traditionally to decrease milk production. There is evidence that there are estrogenic compounds in sage and estrogen is known to reduce milk production.¹⁴ There is no absolute indication to pump and dump.

Fenugreek

Fenugreek is widely used as a galactagogue with some data in rat models suggesting positive impacts on milk production through modulation of insulin regulation and oxytocin secretion.^15,16 However, in a small percentage of those taking it with intention to increase milk production, it had the opposite effect  and decreased milk production in one study.¹⁷ Fenugreek is often used in products that have multiple ingredients, so results may differ based on preparation used. There is no absolute indication to pump and dump.

This section includes substances and medications that have a theoretical or proven risk to milk production. These medications are not routinely used to suppress milk production or manage hyperlactation.

Methylergonovine is used to prevent or treat bleeding from the uterus that occurs with childbirth or abortion. Methylergonovine has been demonstrated in some women to lead to a decrease in serum prolactin or a less robust increase in prolactin in response to suckling  when given in the first week postpartum, leading to less milk produced. However, results are mixed across studies.¹⁸ Most studies demonstrate that rates of exclusive breastfeeding or infant weight gain are not different between treated and untreated.^19,20 While parents should be counseled on the theoretical risks to milk production, there is no absolute indication to pump and dump. For more information on methylergonovine, see the section on Peripartum Medical Conditions.

Steroids can be administered through various routes, including IV, inhaled, orally, topical, or injected. Commonly used steroids include betamethasone, prednisone, and prednisolone. High doses of steroids may lead to a temporary decrease in milk production. In a case report of a single individual injected with a high dose of triamcinolone, there was a decrease in milk production which lasted 3 weeks.²¹ In another case report of injected methylprednisolone, there was a sudden decrease in milk production which resolved after 90 hours (about 4 days).²² Parents should be counseled about the risk for decreased milk production, particularly at higher doses and intravenous administration. There is absolute indication to pump and dump. For more information about steroids, including particular formulations and medications, see the section on Steroids.

For more information about antibiotics of concern during lactation, see the sections on Antibacterial Agents.

Mebendazole

Mebendazole is used to treat infections caused by helminths (worms). There are case reports on the effect of mebendazole on milk production²³, and results are mixed with one case of decreased milk production in a case series of 45 lactating women that took this medication.²⁴ There is no absolute indication to pump and dump.

Nitrofurantoin/Macrobid

Nitrofurantoin is an antibiotic used to treat urinary tract infections. In a prospective follow up study that included 6 nursing mothers who took nitrofurantoin, 1 individual reported a decrease in milk production after taking nitrofurantoin.²⁵ There is no absolute indication to pump and dump.

Antihistamines may pose a risk to milk production with evidence that some more sedating first generation antihistamines decrease milk production by reduction prolactin particularly in the early postpartum period. In general, it is best to select the least sedating antihistamine and use this on an as needed basis only. If possible, the intranasal route is preferred to decrease the risk to milk production. There is no absolute indication to pump and dump with these medications. For more information, see the section on Allergy and Asthma Medications.

High doses of IV epinephrine, such as doses used in cases of anaphylaxis and shock, may decrease serum prolactin and decrease milk production.²⁶ Low dose epinephrine, such as low dose infusion as part of epidural analgesia, an Epi-pen, or inhaled epinephrine is unlikely to affect milk production.^26,27 Due to the risk of decreased milk production, lactation support should be made available to lactating individuals requiring high dose IV epinephrine in cases of anaphylaxis or shock. There is no absolute indication to pump and dump.

Some antihypertensive medications can impact milk production. The concerns and effects on milk production are discussed below. For more information on antihypertensives, see the article on Blood Pressure Medications.

Diuretics

Diuretics include medications such as thiazide diuretics (hydrochlorothiazide and chlorthalidone), loop diuretics (furosemide/Lasix and bumetadine/Bumex), and spironolactone. Diuretics at low doses typically do not impact milk production. Higher doses or more potent diuretics may impact milk production if the patient is over-diuresed.

• Furosemide/Lasix: Furosemide, combined with other methods, has been used to intentionally suppress lactation in the past.²⁸ At lower doses, there is unlikely to be a significant decrease in production. This was also studied in a randomized control trial that examined furosemide when used for postpartum blood pressure stabilization and there was no statistically significant difference in breastfeeding difficulty between the 2 groups.²⁹
• Spironolactone: Spironolactone is an aldosterone antagonist and potassium sparing diuretic. As with any diuretics, if there is intense diuresis, there can be a risk for decreased milk production. There is no absolute indication to pump and dump. For more information, see the sections on  Acne Medications, Blood Pressure Medications, and Endocrine Medications.

Enalapril

Enalapril may decrease prolactin levels, which then could potentially lead to a decrease in milk production.³⁰ While parents should be counseled on the theoretical risk to milk production, there is no absolute indication to pump and dump.

Antidepressants

Sertraline/Zoloft

Zoloft is an SSRI that is most often used to treat depression and anxiety. There is evidence that lactating persons taking Zoloft are at risk of delayed lactogenesis II, but the long-term risks of this delay to overall milk production have not been studied.³¹ There have been reports of short-term decreases in milk production while taking Zoloft, but milk production improved with good hydration and frequent breast emptying.³² There is no absolute indication to pump and dump. For more information, see the section on PMADs.

Antipsychotics

Aripiprazole/Abilify

Aripiprazole is a second-generation antipsychotic medication used alone or in combination to treat various mental conditions. There have been several case reports that aripiprazole leads to decreased lactation and failure, along with decreased prolactin levels, which, in most cases, normalized after stopping aripiprazole. There is also evidence from larger studies supporting the finding that aripiprazole significantly increases the chances of having low prolactin levels.³³ Due to the risks for decreased milk production, alternative agents are preferred. There is no absolute indication to pump and dump. For more information, see the section on Antipsychotic Medications.

Stimulant Medications (Amphetamines, Methylphenidate)

There is a risk of prolactin suppression which can decrease milk production when taking amphetamines or methylphenidate.^34,35 Stimulant medications should be avoided until breastfeeding is well established when possible. For more information on specific medications and other risks to lactation, see the section on ADHD Medications.

Tobacco use can decrease milk production. For more information, please see the section on Tobacco.

While data is limited, there is a theoretical risk to milk production with cannabis use due to potential impacts on prolactin secretion.³⁶ For more information about cannabis use and lactation, see the section on Cannabis.