Management of hyperprolactinemia: Cabergoline

 

Cabergoline is preferred over Bromocriptine for its efficacy and favorable side effect profile (less risk of nausea compared to Bromocriptine). This post will summarize Cabergoline in detail.

 

DOSAGE

  • Initiate 0.25 mg twice weekly (e.g. on Monday and Thursday).
  • Increase the dose by 0.25 mg twice weekly: preferably by adding 0.5 mg per week at monthly intervals until an optimal therapeutic response is achieved
  • Maximum dose: 1 mg twice weekly- based on serum prolactin level.

 

Q: What is advised when doses higher than 1 mg per week are to be given?

  • Division of the weekly dose into multiple administrations is advised

 

Q: How frequently can you increase the dosage?

  • Do not increase dosage more rapidly than every 4 weeks.

 

Q: How frequent is serum prolactin monitoring recommended?

  • Monthly

 

Q: When is serum prolactin normalisation is usually observed?

  • Within 2 to 4 weeks

 

Q: When can you discontinue Cabergoline?

  • Discontinue Cabergoline after normal serum prolactin level has been maintained for 6 months. Continue periodic monitoring of prolactin level if cabergoline should be reinstituted.

MECHANISM OF ACTION

Cabergoline is a dopaminergic ergoline derivative. It acts by direct stimulation of the D2-dopamine receptors on pituitary lactotrophs, thus inhibiting prolactin secretion.

CONTRAINDICATIONS

  • Uncontrolled hypertension
  • History of pulmonary, pericardial and retroperitoneal fibrotic disorders.
  • Known hypersensitivity to this drug or any ergot derivatives and to any ingredient in the formulation.
  • Anatomical evidence of cardiac valvulopathy of any valve (eg, echocardiogram showing valve leaflet thickening, valve restriction, valve mixed restriction-stenosis)

Q: What Investigations are Needed BEFORE Initiating Cabergoline?

  • Echocardiogram: to assess the potential presence of asymptomatic valvular disease.
  • Erythrocyte Sedimentation Rate or other inflammatory markers
  • Lung function/chest X-ray
  • Renal function test

Q: What Cautions are Needed AFTER Initiating Cabergoline?

During treatment attention should be paid to the signs and symptoms of:

  1. Pleuro-pulmonary disease such as dyspnoea, shortness of breath, persistent cough or chest pain.
  2. Renal insufficiency or ureteral/abdominal vascular obstruction that may occur with pain in the loin/flank and lower limb edema as well as any possible abdominal masses or tenderness that may indicate retroperitoneal fibrosis.
  3. Cardiac failure: cases of valvular and pericardial fibrosis have often manifested as cardiac failure. Therefore, valvular fibrosis (and constrictive pericarditis) should be excluded if such symptoms occur.

Source: Cabergoline package insert. 


Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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