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Author8 Posts
  #1

Which one of the following is the preferred method of suppressing lactation in a postpartum patient?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />















Bromocriptine (Parlodel)







Intranasal desmopressin (DDAVP)







Estradiol transdermal system (Estraderm)







Intramuscular leuprolide acetate (Lupron)







Breast binding, ice, and analgesia









  #2

Breast binding, ice, and analgesia


  #3

5-breast binders, ice, analgesia and expression of some amt of milk to prevent engorgement and subsequent mastitis.


  #4

I looked it up...cos I thought it would be bromocriptine.I came across a few articles saying it isn't recommended anymore while there were a few which said it was...still looking.If anyone has a good reference...do post it.


Edited by cyra on Apr 26, 2006 - 11:34 AM

  #5

alright...heres what I found...I am copy pasting the relevant sentences from the following link:

gsm.about.com/compact/showm...p;r=6078&monotype=full

"Although previously used for postpartum breast engorgement and lactation suppression, the indication for postpartum lactation suppression was voluntarily withdrawn by the manufacturer in 1994, following a prior determination by the FDA Fertility and Maternal Health Drugs Advisory Committee that safer and more conservative supportive measures were available. "



  #6

bromocriptine


  #7

According to textbook Breast binding, ice, and analgesia is most effective initial therapy.
The reference: Gabbe: Obstetrics - Normal and Problem Pregnancies, 4th ed., Copyright © 2002 Churchill Livingstone, Inc.
"Lactation Suppression

For those patients who for personal or medical reasons will not breast-feed, breast support, ice packs, and analgesic medications are helpful in ameliorating the symptoms of breast engorgement. The new mother should avoid suckling or other means of milk expression, and the natural inhibition of prolactin secretion will result in breast involution. In 30 to 50 percent of patients, this will be associated with breast engorgement and pain that may last for most of the first postpartum week.[119]

Bromocriptine is no longer approved by the Food and Drug Administration (FDA) for lactation suppression. This ergot derivative is a dopamine receptor agonist with prolonged action that inhibits the release of prolactin. Twenty-three percent of patients have side effects, including symptomatic hypotension, nausea, and vomiting, and 18 to 40 percent have rebound breast secretion, congestion, or engorgement following the termination of therapy.[120] Furthermore, there have been reports of puerperal stroke, seizures, and myocardial infarctions in association with the use of bromocriptine prescribed for lactation suppression.[121] [122] [123] [124] While these events are rare and a causal relationship with bromocriptine has not been established, the manufacturers' prescription recommendations include instructions to avoid the use of this medication in patients with hypertensive complications of pregnancy and to monitor blood pressure periodically during the time the patient is using the drug. Consequently, it can be questioned whether it is prudent to use a medication for 2 weeks that has this incidence of side effects, possibly life-threatening complications, and the requirement for blood pressure monitoring during therapy. Puerperal breast engorgement, although painful, is never fatal and in most instances resolves within the first postpartum week.


  #8

breast binding ice and analgesia






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