The dry-up pill

Can I use the “dry-up pill”?

A drug called bromocriptine, or the dry-up pill, was once used routinely to stop the milk from coming in or to stop milk production in mothers who were weaning their babies. It is no longer recommended for these purposes because its use was associated with stroke, heart attack, seizures, and death. Mothers are usually able to wean safely and effectively without medication but if necessary, cabergoline and lisuride can be used. While safer than bromocriptine, they still have risks.

A) Bromocriptine

The “dry-up pill” (bromocriptine) was routinely used until the 1990s in many high-income countries to stop the milk from coming in and was given right after delivery. It works by blocking prolactin secretion from the pituitary gland.

Bromocriptine is no longer recommended to stop the milk from coming in or to stop the milk from being made because its use was associated with major side-effects, including (Bernard 2015; CMDh 2014; Iffy 1996; Grueger 2013; Marcellin 2015; Oladapo 2009; Snellen 2016):

  • Stroke
  • Heart attack
  • Seizures
  • Psychosis
  • Death

B) Alternative dry-up pills

Medication to stop the production of milk has risks and is rarely needed. It should not be used routinely to stop milk production. Rather there are safe and effective ways to weanbaby and stop making milk without resorting to medication.

Medication may be considered if mothers urgently need to stop making milk as when diagnosed with breast cancerThey are only used rarely and with caution to decrease a large milk supply.

Cabergoline and lisuride may be used to stop the milk from coming or to stop it from being made (Marcellin 2015; Sénat 2015; Tulloch 2019). 

Cabergoline persists in the body for much longer than bromocriptine, possibly making it more effective. The amount of time it takes for the blood level of cabergoline to fall by half (t ½) is 60 or more hours and that of bromocriptine is about 5 hours (Del Dotto 2003; Nelson 1990). 

While in the same drug class as bromocriptine, cabergoline has been found to have fewer side-effects and is generally well tolerated (Aydin 2010; Harris 2020). The most common side effects are dizziness, headaches, and nausea (Yang 2020).

The availability of cabergoline and lisuride varies between countries.

References

Aydin Y, Atis A, Kaleli S, et al. Cabergoline versus bromocriptine for symptomatic treatment of premenstrual mastalgia: a randomised, open-label study. Eur J Obstet Gynecol Reprod Biol. 2010 Jun;150(2):203-6
 
Bernard N, Jantzem H, Becker M, et al.; French Network of Regional Pharmacovigilance Centres. Severe adverse effects of bromocriptine in lactation inhibition: a pharmacovigilance survey. BJOG. 2015 Aug;122(9):1244-51
 
Del Dotto P, Bonuccelli U. Clinical pharmacokinetics of cabergoline. Clin Pharmacokinet. 2003;42(7):633-45
 
European Medicines Agency. Co-ordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh). CMDh endorses restricted use of bromocriptine for stopping breast milk production. Langen: Co-ordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh); 2014 Aug 21 [cited 2017 Oct 24]
 
Grueger B; Canadian Paediatric Society, Community Paediatrics Committee. Weaning from the breast. Paediatr Child Health 2013;18(4):210

Harris K, Murphy KE, Horn D, et al. Safety of Cabergoline for Postpartum Lactation Inhibition or Suppression: A Systematic Review. J Obstet Gynaecol Can. 2020 Mar;42(3):308-315.e20
 
Iffy L, Lindenthal J, Mcardle JJ, et al. Severe cerebral accidents postpartum in patients taking bromocriptine for lactation suppression. Isr J Med Sci 1996;32(5):309-12
 
Marcellin L, Chantry AA. [Breast-feeding (part II): Lactation inhibition--Guidelines for clinical practice]. J Gynecol Obstet Biol Reprod (Paris). 2015 Dec;44(10):1080-3
 
Nelson MV, Berchou RC, Kareti D, et al. Pharmacokinetic evaluation of erythromycin and caffeine administered with bromocriptine. Clin Pharmacol Ther. 1990 Jun;47(6):694-7
 
Oladapo OT, Fawole B. Treatments for suppression of lactation. Cochrane Database Syst Rev 2009;(1):CD005937
 
Sénat MV, Sentilhes L, Battut A, et al. [Post-partum: Guidelines for clinical practice--Short text]. [Article in French] J Gynecol Obstet Biol Reprod (Paris). 2015 Dec;44(10):1157-66 [Article in French]
 
Snellen M, Power J, Blankley G, et al. Pharmacological lactation suppression with D2 receptor agonists and risk of postpartum psychosis: A systematic review. Aust N Z J Obstet Gynaecol. 2016 Aug;56(4):336-40
 
Tulloch KJ, Dodin P, Tremblay-Racine F, et al. Cabergoline: a review of its use in the inhibition of lactation for women living with HIV. J Int AIDS Soc. 2019 Jun;22(6):e25322

Yang Y, Boucoiran I, Tulloch KJ, et al. Is Cabergoline Safe and Effective for Postpartum Lactation Inhibition? A Systematic Review. Int J Womens Health. 2020 Mar 9;12:159-170