Q: I have a 14-month-old baby, whom I breast feed twice a day to put her to sleep. Recently my gynaecologist prescribed Cabgolin 0.5 mg every night for a week to stop the production of milk. Is it safe to use this drug to stop lactating? What are its side effects? Can I take this drug even when I am feeding her, because stopping feeds and taking the drug would result in engorgement, which I don't want? What are the other options?

A:Cabgolin is the brand name; the name of the medicine is cabergoline. It is indicated in (a) the inhibition of physiological (normal) lactation soon after birth due to medical reasons and (b) in the treatment of hyperprolactinaemia (resulting in excessive milk production). The drug is not to be used for routine suppression of physiological (normal) lactation. You have not given your blood prolactin level. Unless it is high, Cabgolin is not indicated. The normal dose in the inhibition of physiological lactation on Day 1 after birth is 1mg only once. If the lactation is already established, the dose is 0.25 mg twice daily just for 2 days. The initial dose in pathological (abnormal) hyperprolactinaemia is 0.5 mg once per week (not daily). If necessary the dose can be increased by 0.5 mg per week i.e. 1mg in all per week. If more than 1mg per week is required, then it should be given in two doses per week such as 0.75 mg twice weekly. Side effects include: nausea, headache, dizziness, fatigue, constipation, breast pain, hot flushes, depression, paraesthesia and sometimes very low blood pressure, dysmenorrhoea etc. Cabergoline is excreted in the milk and hence will reach the baby and produce side effects. In high doses, increased quantity will be in milk and may produce even more side effects. Hence it is not recommended in breast-feeding women.