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.
- 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?
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.
- 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:
- Pleuro-pulmonary disease such as dyspnoea, shortness of breath, persistent cough or chest pain.
- 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.
- 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.
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Dr. Harvinder Singh, M.D. (Admin)
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