What is the proper way to take cabergoline (dopamine receptor agonist)?

How to Take Cabergoline

Cabergoline should be taken at an initial dose of 0.25 mg twice weekly, with gradual increases of 0.25 mg twice weekly up to a maximum of 1 mg twice weekly based on prolactin response, with dose adjustments occurring no more frequently than every 4 weeks. 1

Dosing Protocol

• Starting dose: 0.25 mg twice weekly
• Dose adjustments: Increase by 0.25 mg twice weekly as needed
• Maximum standard dose: 1 mg twice weekly
• Adjustment frequency: Not more often than every 4 weeks
• Duration: Continue until normal prolactin levels are maintained for 6 months, then consider discontinuation with monitoring 1

Administration Tips

• Take with or without food
• Taking doses at night or in small increments can help reduce side effects like gastrointestinal intolerance and postural hypotension 2
• For patients experiencing side effects, small nocturnal dose increments are recommended rather than switching to less effective dopamine agonists 2

Monitoring and Follow-up

• Before starting: Cardiovascular evaluation should be performed; echocardiography should be considered to assess for valvular disease 1
• During treatment:
  • Monitor prolactin levels to assess response
  • Periodic cardiac assessment for patients on long-term therapy 1
  • Annual echocardiography for patients receiving >2 mg/week
  • Every 5 years echocardiography if dose is ≤2 mg/week 2

Special Considerations

• Resistance to standard doses: For patients not responding to standard doses, graduated dose increments up to 3.5 mg per week may be considered 2
• Exceptional cases: Doses up to 7 mg per week may be used in rare situations where lower doses are ineffective 2
• Treatment discontinuation: After normal prolactin levels have been maintained for 6 months, cabergoline may be discontinued with periodic monitoring to determine if/when treatment should be restarted 1

Potential Side Effects to Monitor

• Gastrointestinal symptoms (nausea, vomiting)
• Postural hypotension
• Psychological effects (mood changes, depression, impulse control disorders) 2
• Cerebrospinal fluid leak (rare complication in patients with prolactinomas that have invaded sphenoid bone) 2

Important Precautions

• Cabergoline has a long half-life (63-109 hours), allowing for twice-weekly dosing 3
• Higher doses are typically needed for macroprolactinomas compared to microprolactinomas or idiopathic hyperprolactinemia 4
• Cabergoline is generally better tolerated than other dopamine agonists like bromocriptine 5
• Patients with resistance or intolerance to high-dose cabergoline may require adjuvant therapy with surgery or radiotherapy 2