Can I take cabergoline while pregnant or breastfeeding?

Pregnancy: Teratogenic Effects: Category B. Reproduction studies have been performed with cabergoline in mice, rats, and rabbits administered by gavage. (Multiples of the maximum recommended human dose in this section are calculated on a body surface area basis using total mg/m 2 /week for animals and mg/m 2 /week for a 50 kg human.) There were maternotoxic effects but no teratogenic effects in mice given cabergoline at doses up to 8 mg/kg/day (approximately 55 times the maximum recommended human dose) during the period of organogenesis. A dose of 0.012 mg/kg/day (approximately 1/7 the maximum recommended human dose) during the period of organogenesis in rats caused an increase in post-implantation embryofetal losses. These losses could be due to the prolactin inhibitory properties of cabergoline in rats. At daily doses of 0.5 mg/kg/day (approximately 19 times the maximum recommended human dose) during the period of organogenesis in the rabbit, cabergoline caused maternotoxicity characterized by a loss of body weight and decreased food consumption.

Prescribing label, section “Pregnancy” (opening excerpt): Cabergoline (oral), SOLA Pharmaceuticals, LLC. Read the full section on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

Cabergoline is usually not used during breastfeeding because it suppresses lactation. The U.S. Food and Drug Administration considers cabergoline to be not indicated to suppress lactation because the similar drug bromocriptine has caused hypertension, stroke, seizures and psychosis when used for this purpose. However, two systematic reviews found that cabergoline was generally well tolerated for use in suppressing lactation, but dizziness, headache, nausea and vomiting occur occasionally.[1-3] A retrospective study of 225 women who received cabergoline postpartum had a maximum decrease in systolic blood pressure of 10.88 mm Hg at 20 to 24 hours after the dose.[4] Serious reactions are uncommon, but include thromboembolic and neurologic events. Psychiatric symptoms have occurred rarely, but women requesting lactation suppression with cabergoline are more likely to have anxiety and depression.[5] Some experts recommend cabergoline as a safer alternative to bromocriptine for lactation suppression, but others do not.[6-10] The disadvantage of cabergoline is that it has a half-life of about 68 hours, which means that any adverse effects might persist for a prolonged period of time. Women treated with cabergoline for pituitary adenomas who become pregnant can breastfed their infants with no apparent risk of recurrence. A treatment scheme has been reported for mothers with hypergalactia that uses low doses of cabergoline to decrease milk supply.[11] Decreased milk synthesis may occur by 2 days after drug administration.[12]

“Summary of Use during Lactation”, LactMed record “Cabergoline” (LM451), quoted verbatim. Everything LactMed reports about Cabergoline while breastfeeding.

Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from cabergoline, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Use of cabergoline for the inhibition or suppression of physiologic lactation is not recommended (see PRECAUTIONS section). The prolactin-lowering action of cabergoline suggests that it will interfere with lactation. Due to this interference with lactation, cabergoline should not be given to women postpartum who are breastfeeding or who are planning to breastfeed.

Prescribing label, section “Nursing Mothers”: Cabergoline (oral), SOLA Pharmaceuticals, LLC. Label on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.