Cabergoline scores Over Pyridoxine for Lactation Inhibition in Mothers: AJOG

A recent randomized controlled trial compared the effectiveness of cabergoline and pyridoxine (vitamin B6) for lactation inhibition in postpartum women. This study published in the American Journal of Obstetrics and Gynecology provided clarity on which treatment is more efficient for mothers seeking lactation inhibition for personal, social or medical reasons. 

The trial included a total of 88 postpartum patients who requested lactation inhibition. These women were randomly assigned to receive either cabergoline or pyridoxine. Cabergoline was administered in two different regimens according to departmental protocol, which was either a single 1 mg dose on postpartum day 1 or 0.25 mg twice a day for two days. Pyridoxine was given at a dose of 200 mg three times a day for seven days. Also all participants were screened to exclude those with conditions contraindicating the use of cabergoline like hypertensive disorders and fibrotic, cardiac or hepatic diseases.

The patients assessed their symptoms, including breast engorgement, breast pain and milk leakage, on a scale from 0 (no symptoms) to 5 (severe symptoms) on days 0, 2, 7, and 14. The primary outcome of the study was the success of lactation inhibition that was defined as a score of 0 for both engorgement and pain by day 7. The secondary outcomes included the extent of milk leakage, adverse effects, instances of fever or mastitis and any changes or discontinuations in treatment.

The results showed that cabergoline was significantly more effective than pyridoxine in inhibiting lactation by day 7, with a success rate of 78% when compared to 35% for pyridoxine. Mild symptoms (scores of 0 to 2 for engorgement and pain) were more commonly reported in the cabergoline group. Also, 89% of the cabergoline group underwent mild symptoms against 67% in the pyridoxine group.

Milk leakage was also markedly lower in the cabergoline group with only 9% experiencing leakage after 7 days when compared to 42% in the pyridoxine group. By day 14, these figures were 11% for cabergoline users and 31% for those on pyridoxine.

Despite its higher efficacy, cabergoline did present more adverse effects which was reported by 31% of its users when compared to 9% of pyridoxine users. However, all adverse effects were mild and there were no major complications reported in either group. The rates of mastitis and fever related to engorgement were similar between the two groups.

21% of the patients in the pyridoxine group switched to or supplemented with cabergoline due to inadequate results which further highlighted the superior efficacy cabergoline. Also, the final success rates for pyridoxine decreased when adjusted for these changes. The study concluded that while cabergoline is more effective for lactation inhibition, but pyridoxine remains a viable option for women who cannot use cabergoline due to its contraindications.

Source:

Dayan-Schwartz, A., Yefet, E., Massalha, M., Hosari-Mhameed, S., Remer-Gross, C., Pasand, E., & Nachum, Z. (2024). The efficiency of cabergoline vs pyridoxine for lactation inhibition—a randomized controlled trial. In American Journal of Obstetrics and Gynecology (Vol. 230, Issue 5, p. 561.e1-561.e8). Elsevier BV. https://doi.org/10.1016/j.ajog.2023.10.009