What is the use of Cabergoline (Dopamine agonist)?

From the Guidelines

Cabergoline is the dopamine agonist of choice for treating prolactinoma, offering first-line therapy even in the presence of visual disturbance and pituitary apoplexy, while carefully monitoring for any deterioration in vision, pituitary function, or general status. The use of cabergoline is supported by recent guidelines, including a 2024 consensus guideline for the diagnosis and management of pituitary adenomas in childhood and adolescence, which recommends offering cabergoline as first-line therapy for children and young people (CYP) with prolactinoma 1.

Key Points About Cabergoline Use

• Cabergoline has a longer half-life and greater affinity for the dopamine receptor than other dopamine agonists, making it superior to bromocriptine in normalizing prolactin levels and resuming ovulatory cycles or achieving pregnancy 1.
• The typical starting dose of cabergoline is 0.25 mg twice weekly, which may be gradually increased if needed up to 1 mg twice weekly based on prolactin level response and symptom improvement.
• For patients resistant to standard doses of cabergoline, graduated dose increments of up to 3.5 mg per week or up to 7 mg per week in exceptional cases may be offered 1.
• Cabergoline effectively reduces prolactin levels, shrinks prolactinomas, and resolves associated symptoms like irregular menstruation, infertility, inappropriate lactation, and sexual dysfunction.
• Side effects may include nausea, headache, dizziness, and fatigue, particularly when starting treatment, and patients with heart valve disorders should use caution due to the potential association with heart valve problems at high doses.

Monitoring and Treatment Considerations

• Regular monitoring of prolactin levels and periodic imaging of pituitary tumors are necessary to assess treatment effectiveness.
• Patients should be carefully monitored for any deterioration in vision, pituitary function, or general status, especially when initiating treatment or adjusting doses.
• Cabergoline should be taken with food to minimize stomach upset, and patients should be informed about potential side effects and the importance of adherence to the prescribed treatment regimen.

From the FDA Drug Label

The recommended frequency of routine echocardiographic monitoring is every 6 to 12 months or as clinically indicated with the presence of signs and symptoms such as edema, new cardiac murmur, dyspnea, or congestive heart failure. Physicians should use the lowest effective dose of cabergoline for the treatment of hyperprolactinemic disorders and should periodically reassess the need for continuing therapy with cabergoline.

The use of Cabergoline is for the treatment of hyperprolactinemic disorders.

• It is a dopamine agonist.
• The treatment should be done with caution and with the lowest effective dose.
• Echocardiographic monitoring is recommended every 6 to 12 months or as clinically indicated.
• It is also used for the treatment of Parkinson's disease as mentioned in the study 2.

From the Research

Use of Cabergoline

• Cabergoline is a dopamine agonist used in the treatment of hyperprolactinemia, a condition characterized by elevated levels of prolactin in the blood 3, 4, 5, 6, 7.
• It is effective in normalizing prolactin levels, restoring ovulatory cycles, and reducing tumor size in patients with prolactinomas 3, 4, 5, 6, 7.
• Cabergoline has a high efficacy and tolerability profile, with few patients experiencing unacceptable side effects or inadequate clinical response 3, 4, 5, 6, 7.
• It is also used in the prevention and suppression of puerperal lactation, and has been shown to be more effective and better tolerated than bromocriptine in this indication 4.

Clinical Benefits

• Normalization of prolactin levels in 86% of patients with hyperprolactinemia 3.
• Restoration of ovulatory cycles in 72% of women with hyperprolactinemic amenorrhea 4.
• Reduction of tumor size in 67% of patients with macroprolactinomas 3.
• Improvement of visual field abnormalities in 70% of patients with pretreatment visual field defects 3.

Dosage and Administration

• The median dose of cabergoline is 1.0 mg/week, but can be reduced to 0.5 mg/week once control is achieved 3.
• Patients with macroprolactinomas may require higher doses of cabergoline compared to those with microprolactinomas or idiopathic hyperprolactinemia 3.
• Cabergoline can be administered once or twice weekly, depending on the patient's response and tolerance 6, 7.