Is Bromocriptine Mesilate compatible with breastfeeding? Do we have alternatives for Bromocriptine Mesilate?

Bromocriptine Mesilate

June 25, 2018 (High Risk)

An ergot derivative alkaloid which is a prolactin inhibitor with dopaminergic activity, indicated for the treatment of prolactinomas and Parkinson's disease.
Inhibits milk production by lowering prolactin level (Eglash 2014).
Oral administration two to three times a day.

Severe and frequent side effects, that are even increased in the postpartum, are: hypertension, seizures, stroke, myocardial infarction and psychiatric disorders (Hopp 1996, Iffy 1996, Kirsch 2001, Bernard 2015, Seeman 2015, Fedrizzi 2015, Snellen 2016) and thereof the indication to suppress lactation has been questioned by medical societies (Oladapo 2009-2012 Marcellin 2015, Sénat 2016) withdrawn in many countries (Nguyen 2015), switching to cabergoline has been proposed (Eglash 2014) along with non-pharmacological measures (Wong 1985 , Prescrire Int. 2013)

Pharmacokinetic data (moderately high molecular weight and high binding capacity to plasma proteins) explain the observed almost zero excretion into breastmilk (Peters 1985) or below detection limits (<0.2 micrograms / L).
In addition, a low oral bioavailability makes insignificant its absorption from breastmilk to the infant’s plasma.

A successful breastfeeding has been described on about 30 cases of galactorrhea-prolactinoma-hyperprolactinemia that were treated with a daily dose of 2.5 to 5 mg of Bromocriptine with no effects noticed on the infants (Canales 1981, Cheng 1996, Verma 2006).
Nor side effects occurred on 14 infants whose mothers received 2.5 mg of bromocriptine from 5th to 8th day after birth to treat an alleged galactorrhea (Peters 1985).

The risk on breastfeeding would be due to its ability for suppression of milk production, but not to a possible effect on the infant which is considered very unlikely.
If Bromocriptine was eventually administered to suppress lactation but afterwards the mother is willing to resuming breastfeeding, the mother can do it immediately, trying to minimize the drug effect by frequent suckling the child to stimulate milk production.


See below the information of this related product:

Alternatives

We do not have alternatives for Bromocriptine Mesilate.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • Βρωμοκρυπτίνη μεθανοθειονική (Greek)
  • Бромокриптина Мезилат (Cyrillic)
  • ブロモクリプチンメシル酸塩 (Japanese)
  • (5′S)-2-Bromo-12′-hydroxy-2′-(1-methylethyl)-5′-(2-methylpropyl)-ergotaman-3′,6′,18-trione methanesulphonate (Chemical name)
  • CB-154 (Experimental code/s)
  • G02CB01; N04BC01 (ATC Code/s)
  • C32 H40 BrN5O5,CH4 O3 S ()

Drug trade names

References

  1. Sénat MV, Sentilhes L, Battut A, Benhamou D, Bydlowski S, Chantry A, Deffieux X, Diers F, Doret M, Ducroux-Schouwey C, Fuchs F, Gascoin G, Lebot C, Marcellin L, Plu-Bureau G, Raccah-Tebeka B, Simon E, Bréart G, Marpeau L. Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2016Abstract
  2. Snellen M, Power J, Blankley G, Galbally M. Pharmacological lactation suppression with D2 receptor agonists and risk of postpartum psychosis: A systematic review. Aust N Z J Obstet Gynaecol. 2016Abstract
  3. Christine Nguyen. Clarifying Questions from Bromocriptine Mesylate. Food and Drug Administration. Center for Drug Evaluation and Research. Pharmacy compounding advisory Committee (PCAC). 2015 Full text (in our servers)
  4. Seeman MV. Transient psychosis in women on clomiphene, bromocriptine, domperidone and related endocrine drugs. Gynecol Endocrinol. 2015Abstract
  5. Marcellin L, Chantry AA. [Breast-feeding (part II): Lactation inhibition--Guidelines for clinical practice]. J Gynecol Obstet Biol Reprod (Paris). 2015Abstract
  6. Bernard N, Jantzem H, Becker M, Pecriaux C, Bénard-Laribière A, Montastruc JL, Descotes J, Vial T; French Network of Regional Pharmacovigilance Centres. Severe adverse effects of bromocriptine in lactation inhibition: a pharmacovigilance survey. BJOG. 2015Abstract
  7. [No authors listed] Inhibiting the onset of lactation. Is cabergoline an alternative to bromocriptine? Prescrire Int. 2015Abstract
  8. Serrano Aguayo P, García de Quirós Muñoz JM, Bretón Lesmes I, Cózar León MV. Tratamiento de enfermedades endocrinológicas durante la lactancia. [Endocrinologic diseases management during breastfeeding.] Med Clin (Barc). 2015Abstract
  9. AEMPS. Bromocriptina. Ficha técnica. 2014 Full text (in our servers)
  10. Eglash A. Treatment of maternal hypergalactia. Breastfeed Med. 2014Abstract Full text (link to original source) Full text (in our servers)
  11. [No authors listed] Do not use drugs to prevent onset of lactation. Relieve the discomfort and wait. Prescrire Int. 2013Abstract
  12. Oladapo OT, Fawole B. Treatments for suppression of lactation. Cochrane Database Syst Rev. 2012Abstract
  13. Oladapo OT, Fawole B. Treatments for suppression of lactation. Cochrane Database Syst Rev. 2009Abstract
  14. Verma S, Shah D, Faridi MM. Breastfeeding a baby with mother on Bromocripine. Indian J Pediatr. 2006Abstract
  15. Kirsch C, Iffy L, Zito GE, McArdle JJ. The role of hypertension in bromocriptine-related puerperal intracranial hemorrhage. Neuroradiology. 2001Abstract
  16. Iffy L, McArdle JJ, Ganesh V. Intracerebral hemorrhage in normotensive mothers using bromocriptine postpartum. Zentralbl Gynakol. 1996Abstract
  17. Cheng W, Zhang Z. [Management of pituitary adenoma in pregnancy]. Zhonghua Fu Chan Ke Za Zhi. 1996Abstract
  18. Hopp L, Haider B, Iffy L. Myocardial infarction postpartum in patients taking bromocriptine for the prevention of breast engorgement. Int J Cardiol. 1996Abstract
  19. Iffy L, Lindenthal J, Mcardle JJ, Ganesh V. Severe cerebral accidents postpartum in patients taking bromocriptine for milk suppression. Isr J Med Sci. 1996Abstract
  20. Hopp L, Weisse AB, Iffy L. Acute myocardial infarction in a healthy mother using bromocriptine for milk suppression. Can J Cardiol. 1996Abstract
  21. Pasinetti E, Schivardi MR, Falsetti L, Gastaldi A. [Effects of therapy and pregnancy on hyperprolactemia caused by a pituitary adenoma. A clinical case]. Minerva Ginecol. 1989Abstract
  22. Wong S, Stepp-Gilbert E. Lactation suppression. Nonpharmaceutical versus pharmaceutical method. J Obstet Gynecol Neonatal Nurs. 1985Abstract
  23. Peters F, Geisthövel F, Breckwoldt M. Serum prolactin levels in women with excessive milk production. Normalization by transitory prolactin inhibition. Acta Endocrinol (Copenh). 1985Abstract
  24. Canales ES, García IC, Ruíz JE, Zárate A. Bromocriptine as prophylactic therapy in prolactinoma during pregnancy. Fertil Steril. 1981Abstract