Cabergoline
DOSTINEX
Pronunciation: ka-BER-goe-leen
“Cabbage goal line, Doused next”
milk → treatment for hyperprolactinemia
What it isLong-acting dopamine D2 agonist; hyperprolactinemia and prolactinoma.
Why this oneMore effective and better tolerated than bromocriptine, dosed once or twice weekly.
What limits itCardiac valve fibrosis at the high doses used in Parkinson disease, so echocardiography is needed then. Impulse-control disorders.
FDA-approved for
- hyperprolactinemia (1996)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hyperprolactinemic disorders | Adults | 0.25 mg twice weekly | Titrate to normal serum prolactin | 1 mg twice weekly |
Titration No less than 4 weeks between dose increases
Renal Undefined
Hepatic Mild (Child-Pugh A): no adjustment; moderate (B): increase adverse-reaction monitoring; severe (C): not recommended
Instructions
- Before initiating, evaluate for valvular heart disease including echocardiogram; do not use if valvular disease detected
- May take with or without food
- If discontinued, monitor serum prolactin periodically
Available strengths
- tab 0.5 mg
Contraindications
- Uncontrolled hypertension
- Known hypersensitivity to ergot derivatives
- History of cardiac valvular disorders or pericardial fibrosis
- History of pleural, pulmonary, or retroperitoneal fibrotic disorders
Cautions
- Cardiac valvulopathy and pericardial fibrosis — echocardiogram at baseline and every 6–12 months
- Pleural, pulmonary, and retroperitoneal fibrosis
- Orthostatic hypotension
- Avoid use for inhibition/suppression of physiologic lactation
- Impulse control disorders and compulsive behaviors
Adverse reactions
- Nausea
- Headache
- Dizziness
- Constipation
- Fatigue
- Postural hypotension
Pregnancy If conception occurs, discontinue if maternal/fetal risks outweigh benefits; generally avoid dopamine agonists in pregnancy/postpartum
Lactation Not recommended while breastfeeding; avoid for lactation suppression
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 0.5 mg | tab | 4 q-wk | $5.18 | offered |
Generic entry2005
NO BOXED WARNINGS
Principal riskValve fibrosis at high dose; impulse-control disorders
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
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