Cabergoline

Indications

Cabergoline is used for: Hyperprolactinemia, prolactinomas, parkinson's disease, uterine fibroids, acromegaly, cushing's disease, pituitary adenomas, lactation suppression

Adult Dose

Oral Inhibition of physiological lactation Adult: 1 mg as a single dose on the 1st day postpartum. Suppression of lactation Adult: 250 mcg every 12 hr for 2 days. Hyperprolactinaemia-associated disorders Adult: Initially, 500 mcg/wk then increased at mthly intervals by 500 mcg/wk according to response. Wkly dose may be admin on a single occasion or in 2 divided doses on separate days; doses >1 mg should be given as divided doses. Usual dose: 1 mg (up to 4.5 mg)/wk. As monotherapy in Parkinson's disease; Adjunct to levodopa treatment in Parkinson's disease Adult: Initially, 0.5 mg daily in monotherapy and 1 mg daily as adjunct, may increase in increments of 0.5-1 mg at 7- or 14-day intervals. Max: 3 mg daily. Elderly: Start with lower doses. Hepatic impairment: Dosage adjustments may be needed.

Child Dose

Renal Dose

Administration

Should be taken with food.

Contra Indications

Hypersensitivity to ergot derivatives. Uncontrolled hypertension.

Precautions

CV disease, Raynaud's syndrome, renal or hepatic impairment, peptic ulcer, GI bleeding, history of psychosis, hypertension. May affect ability to drive or operate machinery. Pregnancy, lactation. Prolonged use and/or usage of high doses may lead to psychiatric disorders, pleural/retroperitoneal fibrosis or cardiac valvular fibrosis. Monitor serum prolactin level mthly until normalisation. Monitor hepatic function regularly in patients with hepatic impairment. Lactation: excretion in milk unknown; use with caution

Pregnancy-Lactation

Pregnancy Category: B Lactation: excretion in milk unknown; not recommended

Interactions

Increased risk of orthostatic hypotension when used with antihypertensives. May increase vasoconstriction effect of dopamine. May reduce vasodilation effect of nitroglycerin. Concurrent use with SSRIs or TCAs may increase the risk of serotonin syndrome. Potentially Fatal: Risk of serotonin syndrome with sibutramine.

Side Effects

Side effects of Cabergoline : >10% Nausea (27%), Headache (26%), Dizziness (15%), Constipation (10%) 1-10% Asthenia (9%), Fatigue (7%), Abdominal pain (5%), Somnolence (5%), Postural hypotension (4%), Depression (3%), Dyspepsia (2%), Nervousness (2%), Abnormal vision (1%), Breast pain (1%), Dysmenorrhea (1%), Hot flashes (1%), Paresthesia (1%) Potentially Fatal: Risk of serotinin syndrome with sibutramine; avoid combination.

Mode of Action

Cabergoline is a long-acting dopamine D2-agonist. It inhibits prolactin secretion through hypothalamic inhibitory control exerted through the release of dopamine.