Sooner or later, every breastfeeding woman is faced with the issue of stopping lactation. There are plenty of remedies available today to help reduce breast milk production. One of these drugs is Dostinex.
- 2 Composition and use for cessation of lactation
- 3 Contraindications and side effects during use
- 4 Advantages and disadvantages of the drug
- 5 Table: Dostinex analogues
5.1 Photo gallery: drugs with similar effects
- 7.1 Video: how to wean a child from breastfeeding, Dr. Komarovsky’s school
Pharmacological properties
It is a dopamine receptor agonist. The drug contains a substance - cabergoline - a derivative of ergoline, which is characterized by a long-term and pronounced prolactin-lowering effect. The principle of action is based on direct stimulation of dopamine D2 receptors, which are present in the lactotropic cells of the pituitary gland. In dosages to lower the level of prolactin in the blood, the medication has a central dopaminergic effect, which is caused by the activation of dopamine D2 receptors.
A decrease in the level of lactogenic hormone in the blood plasma is observed after taking the medicine approximately three hours later and persists for 1-4 weeks in healthy women and patients suffering from hyperprolactinemia, as well as 2-3 weeks in women during the postpartum period. The suppressive effect of prolactin production is dose-dependent in both duration and severity.
The main active element has a selective effect and does not affect the basal production of other hormones produced by the pituitary gland and cortisol.
The pharmacological actions of cabergoline, not related to the therapeutic effect, include a decrease in blood pressure. With a single use of this drug, maximum hypotensive activity is observed during the first six hours and is dose-dependent.
Reviews about Dostinex tablets are mostly positive.
The role of prolactin in lactation
Prolactin plays the most important role in milk production in the female body. Its action leads to physiological hyperprolactinemia in the earliest stages of pregnancy. Prolactin, together with estrogens and progesterone, cause hyperplasia of the cells responsible for the secretion of milk in the female body - lactotrophs. In addition, throughout pregnancy, prolactin takes an active part in stimulating the secretory apparatus of the mammary glands of a pregnant woman.
During the first 12 hours after the birth of a child, the percentage of prolactin in the mother’s blood decreases sharply, and in the next 2-3 weeks it stabilizes at the level before pregnancy. However, in the mammary glands, prolactin remains in increased quantities, the interaction of the milk duct receptors with the hormone occurs and the process of secretion of breast milk is enhanced.
The mother's body is prepared for the process of lactation by nature itself. This is evidenced by the fact that during sucking the production of prolactin is stimulated, that is, each feeding physiologically enhances lactation.
Existing drugs for reducing lactation can sharply reduce the level of prolactin in the bloodstream of a nursing mother within 1 - 2 hours after taking the first dose. Is it necessary to express milk when taking Dostinex, and what is this medicine? Is lactation possible after Dostinex?
Release form and composition of the drug
This medicine is produced in the form of white tablets, which have a special notch for easy separation. The tablets are packaged in bottles of 2 and 8 pieces.
The active ingredient of the drug is cabergoline, in addition to which it contains some additional elements: anhydrous lactose (milk sugar) and leucine (amino acid).
We will consider reviews of the use of Dostinex later.
Indications for use
In accordance with the instructions for use, this medication is prescribed in the following cases:
- the need to completely prevent lactation after childbirth;
- the need to stop already formed lactation;
- prolactin-secreting pituitary adenomas;
- empty sella syndrome in combination with hyperprolactinemia;
- idiopathic hyperprolactinemia;
- other disorders associated with hyperprolactinemia (anovulation, galactorrhea, oligomenorrhea, amenorrhea).
But most often the drug is prescribed to reduce prolactin. According to reviews, Dostinex is suitable for most women.
Contraindications
Despite the fact that this drug is not hormonal in the original sense, it can significantly change a woman’s hormonal background. Activation of the performance of the neurotransmitter dopamine, which suppresses the secretion of prolactin, represents a serious interference in natural human physiology, and therefore the drug Dostinex has a certain list of contraindications. These include:
- age less than 16 years (relevant clinical trials have not been conducted, so the safety and effectiveness of using a medication in adolescence are unknown);
- intolerance or individual sensitivity to cabergoline, additional substances of the drug (lactose and leucine) and to any ergot alkaloids (a type of parasitic fungus).
According to reviews from women, Dostinex is usually well tolerated.
In addition to taking into account the main contraindications, negative consequences when using the product can occur when:
- severe stages of liver failure;
- peptic ulcers and intestinal or gastric bleeding;
- severe stages of diseases of the cardiovascular system, as well as Raynaud's disease;
- disturbances of the normal respiratory process and heart function due to fibrotic changes (including a history);
- severe forms of mental and cognitive disorders;
- arterial hypertension that occurs during pregnancy (this medication is allowed to be taken only when the effectiveness of treatment significantly outweighs the risk of potential negative consequences).
Advantages and disadvantages of the drug
The advantages of the medicine include its rapid effectiveness. The effect occurs within 3 hours after taking the tablet. However, the drug has a lot of side effects, and is also difficult to tolerate. Another disadvantage is the mandatory monitoring of the level of the hormone prolactin and the high cost of the drug.
In addition, it is not recommended to take Dostinex without a full examination of the function of the pituitary gland, taking tests and checking the condition of the cardiovascular system. The pharmacy chain offers a number of medications based on cabergoline with a similar effect.
Pharmacodynamics and elimination
After taking the medication, cabergoline (the active component) is quickly absorbed through the intestinal wall and enters the general bloodstream, reaching its maximum concentrations after 1-3 hours. Food does not affect the concentration and absorption of this active substance. It causes a response from dopamine receptors located in the lactotropic cells of the pituitary gland and an increase in the level of dopamine, which is a neurotransmitter that significantly inhibits the secretion of prolactin.
The level of lactogenic hormone begins to decrease approximately four hours after taking the medication and remains at a constant level for quite a long time: in healthy women and women suffering from hyperprolactinemia - from 7 to 28 days, during breastfeeding - from 14 to 21 days. There is a direct relationship between the dosage of the drug and the duration and severity of the decrease in prolactin levels.
Cabergoline has a selective effect and does not have a significant effect on the synthesis of other hormones, but can lower blood pressure. After a single dose of the drug, it remains reduced for several hours, and the strength of the decrease directly depends on the dosage.
If you stop breastfeeding only for a certain period of time, you can restore the lactation process after completely eliminating the reasons that forced it to be interrupted. It must be remembered that the longer a woman takes this medication, the more difficult it is to restore milk production.
According to reviews, Dostinex leads to cessation of lactation very quickly.
First aid drug to reduce lactation
Dostinex is the third generation of dopamine antagonists and has a long-term effect of suppressing prolactin. The effect of the drug begins almost instantly: after 25 - 30 minutes the medicine is absorbed from the digestive tract and concentrated in the blood in a therapeutic dose.
The level of milk hormones in the body of a nursing woman begins to decrease within 2 - 3 hours after taking the initial dose of Dostinex and persists for 2 - 3 weeks. The drug is excreted from the body through the kidneys and genitourinary system. This process can last up to 3 days, so short-term use of the medicine rarely meets the expectations of nursing women and causes natural complaints, for example, of the following kind: I drank Dostinex, but the milk remains.
Dosage and method of administration
The dosage of the medication is determined by the reason for prescribing Dostinex. In order to stop already established lactation, half a tablet is taken twice a day for two days (i.e. in a total volume of 1 mg). If there is a risk of hypotension, the single dosage should not exceed 0.25 mg (half a tablet).
In order to prevent lactation that has not yet formed, take a single dose of 1 mg (2 tablets) on the second day after birth.
In cases of hyperprolactinemia (increased secretion of prolactin), it is recommended to take the medicine 1 tablet per week or divide the dose into two times, half a tablet. The weekly dosage of Dostinex should be increased extremely carefully - by 0.5 mg once a month until the required therapeutic effect is achieved. The maximum dose for women with hyperprolactinemia is 9 tablets per week.
Since the tolerability of this drug is individual in each case, a specialist may recommend taking one dose in several approaches. This is usually done if the dosage of the medication exceeds 2 tablets per week.
It is better to read reviews about Dostinex in advance.
How to use Dostinex
The medicine can very quickly stop lactation. The instructions for use advise using it for no more than two days. Dostinex is prescribed as half a tablet (2.5 mg) twice a day, with a 12-hour break. If the drug is stopped, milk production from the nipples should stop after finishing taking it. The unpleasant feeling of fullness in the chest also disappears. When a medicine is prescribed in connection with mastitis, its symptoms may decrease as lactostasis, one of the causes of the disease, disappears.
Women who drink Dostinex should closely monitor their well-being. The drug has a number of side effects. If you feel unwell, you should consult a doctor. He will decide whether to stop the medicine or complete the course. It is important to remember that taking Dostinex cannot be combined with other drugs from the ergot alkaloid group. There are also contraindications for use with drugs that act on dopamine receptors (phenothiazine, metopromide, thioxanthene, butyrofen). You should also not take medicine with antibiotics from the macrolide group (azithromycin, erythromycin, rovamycin, etc.)
Overdose symptoms
In such situations, the following pathological conditions are observed:
- vomiting, nausea;
- orthostatic hypotension (sharp decrease in blood pressure);
- dyspeptic disorder (stomach pain, indigestion);
- psychosis, hallucinations, confusion.
These phenomena are eliminated by maintaining normal blood pressure levels and gastric lavage. In some cases, the use of dopamine antagonists may be required.
Adverse reactions
According to reviews of Dostinex, side effects still occur.
Similar negative phenomena occur in most women. Thus, during trials with a single dose of 1 mg (to prevent lactation) and a dosage of 0.25 mg twice a day for two days (to stop lactation), side effects were observed in 13% of subjects. When the duration of the study was extended to six months, adverse reactions began to bother 70% of women.
The list of main side effects from the use of this medication is very long. Among them:
- Nervous system: severe headaches, excessive drowsiness, asthenic phenomena, paresthesia, increased fatigue, dizziness, fainting, depressive disorders.
- Digestive system: gastritis, dyspepsia, pain in the abdomen and epigastric region, vomiting, nausea, stool retention.
- Cardiovascular system: orthostatic hypotension, low blood pressure during the first few days after birth.
- Other: spasm of capillary vessels in the fingers, cramps in the legs (as a result of the vasoconstrictor properties of the drug), flushing of the face, nosebleeds, hemianopsia, alopecia, mastodynia, dyspnea, valvulopathy, fibrosis, swelling, liver dysfunction, rashes, respiratory failure, other respiratory disorders, increased levels of creatine phosphokinase, mania.
All this is confirmed by reviews of Dostinex. The cessation of lactation, of course, occurs, but it is important to understand that against the backdrop of an impressive list of side effects, you should not continue breastfeeding your child while using this medication.
Reviews
I breastfed my daughter 1y and 4m. First, I reduced the number of daytime feedings, leaving them before naps and at night, and then only at night. This is where the problem arose - milk stagnation began. Thanks to timely consultation with a doctor, serious problems were avoided. Breastfeeding had to be stopped. Dostinex helped suppress lactation. After about a day, less milk began to arrive, and after 7–10 days it stopped altogether. While taking the medicine I experienced nausea and dizziness, but I am happy with the result.
Alinka-Malinka
https://otzovik.com/review_183260.html
I fed my child until he was 1 year 3 months old. On “Komarovsky’s advice,” they decided to excommunicate him on Friday and give the boy to his grandmother for the weekend. I bought Dostinex, it is recommended as the most easily tolerated hormonal drug. The milk began to leave only on the 6th day, while the breasts became full and very painful. There were no side effects other than severe depression.
inna2222
https://otzovik.com/review_460489.html
When my baby was 1 year and 1 month, it became necessary to wean him from breastfeeding. The doctor prescribed Dostinex. This is where the problems started. My blood pressure has always been low - 110/70, and after taking the first pill it dropped to 90/60, after the second - 80/50, terrible heartbeat, reaching 150 beats per minute. I went to the cardiologist. When I explained the situation to her, she was outraged by taking Dostinex without properly examining me. I took tests, underwent an examination, took medications, but I still feel the effects of taking these hormones. Next time I’ll think a hundred times before listening to doctors!
Pero1983
https://otzovik.com/review_294872.html
I urgently needed to stop breastfeeding my one-and-a-half-year-old daughter, as she was due to be treated with antibiotics. My gynecologist prescribed me to take 2 tablets of the hormonal drug Dostinex for 2 days. That is, half a tablet every twelve hours. This dosage is exactly what is sold in pharmacies, although there is also a larger quantity in a jar. I started taking it, there didn’t seem to be any side effects at first, I was a little dizzy and one of my breasts hurt. After taking 2 tablets I developed a high fever. In the morning she returned to normal. When I started pumping, I discovered that thick pus was coming out of the duct from the sore breast. The milk supply decreased only on the third day. There seem to be no other means to stop lactation, so Dostinex alone is prescribed. I don't know what caused the inflammation in my chest.
Garita
https://otzovik.com/review_2074706.html
I would like to share my experience of taking the drug Dostinex. On the plus side, I want to say that it suppresses lactation very quickly. For those women who want to use this drug to suppress lactation, this drug will come in handy. But with a diagnosis of prolactinemia, you need to be careful with Dostinex, since it has a bunch of side effects. I took the medicine for 8 months. There was an effect, but only while taking it (I started taking it due to high prolactin and lack of a menstrual cycle). But I was in a foggy state all the time. And after 6 months, severe bone loss began. My doctor stopped the medication. And he also said such a thing that the manufacturers of the drug did not really try it. And after that, all my problems with prolactin came back.
190607
https://otzovik.com/review_102482.html
Expressing while using the drug
After taking the initial dose of this drug, significant changes may not be replaced, the breasts become very full, there are no feelings of discomfort, according to reviews of the cessation of lactation with Dostinex.
Whether it is necessary to pump during this period is an individual question. However, engorgement of the glands and their overflow are the first signs of lactostasis. In this case, it is imperative to express milk. With lactostasis, there is a high probability of developing mastitis and infection, so it is extremely important not to start such a process. It should be remembered that pumping should not cause significant discomfort. In this case, a relaxing massage of the glands is performed, which normalizes the outflow of milk and eliminates existing seals. There is no need to completely empty your breasts. It only needs to be expressed until relief occurs, and the remaining milk in the breast burns out on its own. In case of lactostasis, it is necessary to massage the breasts as often as possible to prevent stagnation.
The next time your milk arrives, you should not worry about this, since its quantity decreases each time you take the drug and will soon disappear completely.
That is why reviews of Dostinex for elevated prolactin are mostly positive, even despite the large number of side effects.
Many women are advised to bandage their breasts, because it is believed that this way the milk disappears faster, but this should never be done, since this causes blockage of the ducts, which can subsequently lead to the development of lactostasis. It is very important to reduce the amount of liquid consumed so that milk does not continue to be produced.
Reviews of Dostinex tablets are presented at the end of the article, but for now let’s look at the analogues.
Operating principle
After taking Dostinex tablets orally, its active components are quickly absorbed by the intestinal tissues. After 30 minutes, the onset of action of the drug is noted, and the maximum accumulation of cabergoline is recorded after 4 hours. In response to cabergoline entering the body, the reaction of dopamine receptors in the pituitary gland begins. Dopamine levels increase, and prolactin levels gradually decrease. The effect of the drug does not decrease or increase depending on the simultaneous consumption of food.
In patients who have been diagnosed with hyperprolactinemia, the decrease in prolactin lasts 1-4 weeks, in women during breastfeeding it lasts 2-4 weeks. There is a direct relationship between the amount of Dostinex taken and the duration of the decrease in the hormone in the body.
Cabergoline affects only dopamine receptors, without affecting other hormonal structures, but is able to reduce blood pressure levels. Moreover, the larger the dose of pills a woman took, the longer and more strongly the tonometer readings fall. If the patient has taken Dostinex for a long time, it will be difficult to restore lactation.
Analogs
Medicines with similar effects are:
- "Bromocriptine" is a domestically produced medicine that is a dopamine receptor stimulator. This medication reduces the production of prolactin, as a result of which the lactation process is suppressed. In addition to cessation of lactation, this medicine is also prescribed for delayed menstruation, premenstrual syndrome, tumor formations in the breast, hyperprolactinemia in men and Parkinson's disease.
- "Bromocriptine" is a Hungarian-made medical product. It has the same properties as Dostinex and effectively stops lactation processes.
- "Norprolac" is a drug that suppresses the secretion of prolactin using the active substance quinagolide. Indications for use include cessation of lactation and hyperprolactinemia.
Dostinex's analogs
If Dostinex, for objective reasons, cannot be used by a woman to stop milk production, then you can try its analogues (the choice and dosage is made by the attending physician).
Popular analogues:
- Bromocriptine - has a similar effect and is also used to treat infertility. The price is several times cheaper than Dostinex.
- Agalates is an identical active ingredient, but there are more side effects and contraindications. In case of an overdose, constipation, exacerbation of chronic gastritis, drowsiness, and vascular spasms are possible.
- Bergolak - there is no significant difference between the drugs, the composition is the same for different manufacturers.
- Bromcamphor - the effect of prolactin decreases slowly, with no side effects. The main substance of the drug is bromine.
- Parlodel - used to restore the menstrual cycle, control prolactin in a woman’s body. Reduces the volume of malignant tumors.
even if lactation had to be completed for some reason, the mother will give the child equally important and valuable attention, love and care.
Dostinex is used to prevent or stop the lactation process; the active substance, cabergoline, is characterized by a pronounced prolactin-lowering effect. Taken orally in tablet form, it is quickly absorbed from the gastrointestinal tract. It is prescribed by a doctor and, when used correctly, minimizes the risk of complications when suppressing lactation.
Reviews about Dostinex
Reviews about this medication are mostly good, and this is especially true for cessation of lactation, but there are also negative ones, which describe numerous side effects from the use of this medicine.
Patients who took Dostinex observed that they stopped producing milk a maximum of a week after starting to take it, but this is in cases where the woman’s hormonal background is normal and there is no hyperprolactinemia. In some patients, a decrease in the activity of the mammary glands was noted already on the second day. Reviews of Dostinex also describe isolated cases in which milk ceased to form on the first day, and women did not even have to express it.
Almost everyone who was treated with this drug when stopping breastfeeding experienced numerous side effects. The most common of these are severe nausea, severe dizziness, and weakness.
We reviewed reviews of tablets for stopping lactation "Dostinex".
Side effects and contraindications
Dorstinex for suppressing lactation has a number of side effects. They are not as pronounced as with other drugs in this series, but you need to pay attention to them. Patients experience:
- Orthostatic collapse or a sharp drop in pressure when changing body position.
- Arterial hypotension.
- Dizziness.
- Nausea and vomiting.
- General weakness, lethargy.
- Sleep disturbance, drowsiness or insomnia.
- Decrease in hemoglobin level in the blood.
- Nervous excitement.
The drug is contraindicated for stomach ulcers, chronic gastritis, liver and kidney failure. It is not recommended for people with low blood pressure or severe heart and lung diseases. There are not enough studies to allow prescribing the medicine to children under 16 years of age and pregnant women.
