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  • cabergoline-dostinex

    Dear Dr Hale,
    I would like to get youre proffessional opinion,
    We have a disagreement between some of our IBCLC's in Israel. The question is: A woman after birth took Dostinex to stop breastfeeding, then regreted and wishes to continue breastfeeding. Until now we used to say its Ok just need to observe the baby for potential ergot side effects. Now we hear some recommendations to pump and throw her milk for 5*T 1\2
    I hope you can give us a very clear answer, on what to tell the mom.
    Thank you,
    Orli Amram
    Public Health Office Ashkelon Israel

  • #2
    Orli:

    We have no data on the transfer of this drug into human milk. Rat studies show some transfer, but they are worthless in comparison to humans. This drug is extensively taken up first pass by the liver, and I would assume oral absorption is low.
    In utero, exposure to this ergot alkaloid is largely without complications (category B), thus I really doubt the exposure to breast milk would be a real complication.

    That said, we do not know if levels in breastmilk are significant. I doubt they are and waiting 63 X 24 would be 13 days.

    I don't personally think a waiting period is necessary but I have no data to support this.

    Tom Hale Ph.D.

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    • #3
      Thank you very much for the quick reply.

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      • #4
        I am caring for a mom of twins born at 34 weeks in the NICU that had a "pituitary tumor" in the past and took Cabergoline for 2 years before stopping to enter into fertility treatment. Despite her consistent stimulation of her breasts, skin to skin with the babies and all the non galactogue techniques to increase her supply. By day 5 she was pumping about 8-10 ml/day and now at 2 weeks has increased to 325ml/day. Due to her past use of Cabergoline, would this affect her supply at this time? Do you think getting prolacin levels would be justified? Would it be safe to be on Reglan or Domperidone? She is now taking Fenugreek, Mother's Milk Tea and eating oatmeal per her internet search.

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        • #5
          Dear milkmam3

          I do not believe the cabergoline mom took in the past is effecting moms milk supply now. It could not hurt to have moms prolactin levels checked. Do this by having mom pump, then wait 2 hours to have the levels drawn. Normally, if the mother's levels are low (10-50 ng/ml) then it would probably be beneficial to have her start domperidone at 10mg three times a day to start, and may increase to 20mg three times a day, but do not exceed this amount because this medication could cause a prolonged QT interval, resulting in arrhythmias.

          However, i strongly advise you in this case to consult an endocrinologist before using domperidone, because the mother has a history of a pituitary tumor. Furthermore, mom should be advised if she has any preexisting heart conditions to have an EKG prior to starting this med, and 3 weeks after starting the med to make sure there are no changes.

          If you have any more questions please contact the Infant Risk Center at 806-352-2519

          Sandra Lovato R.N.
          InfantRisk Center

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          • #6
            Good morning Dr Hale

            I am currently working with a mother who was given Dostinex in 2 doses from Tuesday night. She was told that baby could not latch and that she could not mix formula and breastmilk. I am now trying to get her relactating and have her pumping until we can get baby to latch. My question is, is the milk she is pumping safe to give to the baby?

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            • #7
              Hi, thanks for your post.

              There are no studies at all concerning the transfer of Dostinex into human milk, nor do we have toxicology studies about the specific effect of this drug on nursing infants. The half-life is long (65 hours) and the pharmacological properties suggest that it probably gets into milk, but only minimally. It's doubtful if it is clinically relevant.

              It is likely that a waiting period is not necessary for this drug. If you have an excess of milk stored, you might consider discarding the first 12 hours or so to reduce the risk a little more. If not, use what you have; the benefits of breastmilk likely exceed the risk of incidental drug exposure in this case. Watch the baby for signs of ergot toxicity: drowsiness or insomnia, dry mouth, or constipation. In the absence of symptoms, there should be no harm to the baby.

              Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

              -James Abbey, MD
              and
              -Thomas W. Hale, Ph.D.

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