Drug Action
Cabergoline is a stimulant of dopamine receptors in the brain and it also inhibits release of prolactin by the pituitary.
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Drug reference
Cabergoline is a stimulant of dopamine receptors in the brain and it also inhibits release of prolactin by the pituitary.
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Prevention of lactation ▶BY MOUTH ▶Adult: 1 mg, to be taken as a single dose on the first day postpartum Suppression of established lactation ▶BY MOUTH ▶Adult: 250 micrograms every 12 hours for 2 days Hyperprolactinaemic disorders ▶BY MOUTH ▶Adult: Initially 500 micrograms once weekly, dose may be taken as a single dose or as 2 divided doses on separate days, then increased in steps of 500 micrograms every month until optimal therapeutic response reached, increase dose following monthly monitoring of serum prolactin levels; usual dose 0.25–2 mg once weekly, usually 1 mg weekly; reduce initial dose and increase more gradually if patient intolerant, doses over 1 mg weekly to be given as divided dose; maximum 4.5 mg per week Alone or as adjunct to co-beneldopa or co-careldopa in Parkinson’s disease where dopamine-receptor agonists other than ergot derivative not appropriate ▶BY MOUTH ▶Adult: Initially 1 mg daily, then increased in steps of 0.5–1 mg every 7–14 days, concurrent dose of levodopa may be decreased gradually while dose of cabergoline is increased; maximum 3 mg per day
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Avoid in pre-eclampsia. cardiac valvulopathy—exclude before treatment (does not apply to suppression of lactation). history of pericardial fibrotic disorders. history of puerperal psychosis. history of pulmonary fibrotic disorders. history of retroperitoneal fibrotic disorders
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Cardiovascular disease. history of peptic ulcer (particularly in acromegalic patients). history of serious mental disorders (especially psychotic disorders). Raynaud’s syndrome CAUTIONS, FURTHER INFORMATION ▶Hyperprolactinemic patients In hyperprolactinaemic patients, the source of the hyperprolactinaemia should be established (i.e. exclude pituitary tumour before treatment).
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Cabergoline should not be used in patients with hypersensitivity to ergot alkaloids.
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Dispense in original container (contains desiccant).
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FIBROTIC REACTIONS Cabergoline has been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions. Manufacturer advises exclude cardiac valvulopathy with echocardiography before starting treatment with these ergot derivatives for Parkinson’s disease or chronic endocrine disorders (excludes suppression of lactation); it may also be appropriate to measure the erythrocyte sedimentation rate and serum creatinine and to obtain a chest X-ray. Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness. If long-term treatment is expected, then lung-function tests may also be helpful. Patients taking cabergoline should be regularly monitored for cardiac fibrosis by echocardiography (within 3–6 months of initiating treatment and subsequently at 6–12 month intervals). IMPULSE CONTROL DISORDERS Treatment with dopamine-receptor agonists are associated with impulse control disorders, including pathological gambling, binge eating, and hypersexuality. Patients and their carers should be informed about the risk of impulse control disorders. Ergot- and non-ergot- derived dopamine-receptor agonists do not differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists will not control these side-effects. See Parkinson’s disease p. 429.
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→Appendix 1: dopamine receptor agonists
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▶Common or very common Angina pectoris. asthenia. cardiac valvulopathy. confusion. constipation. dizziness. drowsiness. dyspepsia. dyspnoea. gastritis. hallucination . headache. hypotension. movement disorders. nausea. oedema. pericardial effusion. pericarditis. sexual dysfunction. sleep disorders. vertigo. vomiting ▶Uncommon Delusions. erythromelalgia. hepatic function abnormal. psychotic disorder. rash. respiratory disorders ▶Rare or very rare Fibrosis ▶Frequency not known Aggression. alopecia. chest pain. digital vasospasm. leg cramps. pathological gambling. syncope. tremor. visual impairment
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Exclude pregnancy before starting and perform monthly pregnancy tests during the amenorrhoeic period. Caution—advise non- hormonal contraception if pregnancy not desired. Discontinue 1 month before intended conception (ovulatory cycles persist for 6 months).
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Discontinue if pregnancy occurs during treatment (specialist advice needed).
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Suppresses lactation; avoid breast- feeding if lactation prevention fails.
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Manufacturer advises caution in severe impairment (risk of increased of exposure). Dose adjustments Manufacturer advises consider dose reduction in severe impairment.
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▶Monitor for fibrotic disease. ▶Monitor blood pressure for a few days after starting treatment and following dosage increase.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 10, 21 ▶Cabergoline (Non-proprietary) Cabergoline 500 microgram Cabergoline 500microgram tablets | 8 tablet P £34.99 DT = £34.99 Cabergoline 1 mg Cabergoline 1mg tablets | 20 tablet P £66.00 DT = £64.25 Cabergoline 2 mg Cabergoline 2mg tablets | 20 tablet P £73.14 DT = £73.12 ▶Cabaser (Pfizer Ltd) Cabergoline 1 mg Cabaser 1mg tablets | 20 tablet P £83.00 DT = £64.25 Cabergoline 2 mg Cabaser 2mg tablets | 20 tablet P £83.00 DT = £73.12 ▶Dostinex (Pfizer Ltd) Cabergoline 500 microgram Dostinex 500microgram tablets | 8 tablet P £30.04 DT = £34.99
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Antiparkinsonian drug therapy should never be stopped abruptly as this carries a small risk of neuroleptic malignant syndrome.
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Driving and skilled tasks Sudden onset of sleep Excessive daytime sleepiness and sudden onset of sleep can occur with dopamine-receptor agonists. Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring. Management of excessive daytime sleepiness should focus on the identification of an underlying cause, such as depression or concomitant medication. Patients should be counselled on improving sleep behaviour. Hypotensive reactions Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.
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1 mg, to be taken as a single dose on the first day
First-line fragment. Read the complete Indications and Dose section above.
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250 micrograms every 12 hours for 2 days
First-line fragment. Read the complete Indications and Dose section above.
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Initially 500 micrograms once weekly, dose may
First-line fragment. Read the complete Indications and Dose section above.
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Initially 1 mg daily, then increased in steps of
First-line fragment. Read the complete Indications and Dose section above.
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