Bromocriptine and other prolactin inhibitors

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Experience

Bromocriptine is an ergotamine derivative. As a prolactin inhibitor, it reduces the milk production and is used to treat prolactinoma. Because of the possible cardiovascular side effects in the mother, particularly the threat of cerebral angiopathy (Hopp 1996, Iffy 1996), it has a very limited use in stopping lactation (see also section 3.7).

4.11.4 Thyroid hormones and thyroid receptor antibodies

The American Food and Drug Administration (FDA) has withdrawn permission to use bromocriptine for this purpose (Herings 1995). Following a dosage of 2.5 mg, less than 0.1 pg/1 can be expected to appear in the mother's milk; this represents 0.04% of the maternal weight-related dosage (reported by manufacturer Sandoz).

Intolerance in the breastfed baby, even with prolactinoma treatment. has not been observed (Canales 1981). Even after an intake of 5 or 10 mg daily, no side effects via the mother's milk are to be expected in the infant.

The effect of breastfeeding on the growth of the prolactinoma appears to be more limited than that of the pregnancy, so an interruption of dopamine agonist treatment with bromocriptine during breastfeeding can be considered (Rau 1996).

Cabergoline is taken less often (e.g. once a week) because of its considerably longer half-life and period of effectiveness. In addition. there seem to be fewer side effects. With respect to the other prolactin inhibitors, lisuride, metergoline, and qiunagolide, experience during breastfeeding is insufficient.

Recommendation, Because of maternal risks, routine prescription of bromocriptine to stop lactation is not indicated. If physical measures (and, in cases of mastitis, antibiotic treatment) are insufficient cabergoline should be preferred (see also Chapter 3.7). If therapy with prolactin inhibitors for mastitis is unavoidable, the briefest and lowest dosage should be used so that milk production will not diminish. As long as milk is being produced, breastfeeding may continue, even when cabergoline is being given. In so far as other experience is available, this also applies to the other prolactin inhibitors. If the milk supply has diminished during antiprolactin treatment, relactation may be undertaken if desired.

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