Cabergoline Side Effects
Cabergoline commonly causes nausea, headache, dizziness, fatigue and gastrointestinal disturbances, but has a significantly better side effect profile than other dopamine agonists like bromocriptine (52% vs 72% adverse events). 1
Common Side Effects
- Gastrointestinal effects: Nausea, vomiting, and gastrointestinal discomfort are among the most frequently reported side effects 2
- Neurological symptoms: Headache (26%), dizziness (27%), and paresthesia (5%) are common neurological side effects 2
- Fatigue-related symptoms: Asthenia (13%), fatigue (10%), and somnolence (5%) are frequently reported 2
- Psychiatric effects: Depression (7%), anxiety (3%), insomnia (3%), and impaired concentration (2%) can occur 2
- Cardiovascular effects: Hot flashes (6%), hypotension (3%), dependent edema (2%), and palpitations (2%) may occur 2
Dose-Dependent vs. Dose-Independent Side Effects
- Dose-dependent effects: Gastrointestinal intolerance and postural hypotension can be minimized by using small nocturnal dose increments 3, 1
- Dose-independent effects: Psychological side effects including mood changes, depression, aggression, hypersexuality, and impulse control disorders are not related to dose but to the dopaminergic effect of the medication 3, 1
Serious Side Effects
- Cardiac valvulopathy: Particularly at higher doses (>2 mg/week), cabergoline may cause cardiac valve problems, requiring echocardiographic monitoring 1
- Cerebrospinal fluid leak: Medication-induced shrinkage of prolactinomas that have invaded sphenoid bone can cause rhinorrhea due to cerebrospinal fluid leakage 3
- Impulse control disorders: Pathological gambling, hypersexuality, and increased libido have been reported during post-marketing surveillance 2, 4
- Psychiatric disturbances: Rare cases of manic episodes, psychosis, and aggression have been reported 2, 4
Monitoring Recommendations
- For patients on >2 mg/week, annual echocardiography with cardiac auscultation is recommended 1
- For patients on ≤2 mg/week, echocardiographic surveillance can be reduced to every 5 years 1
- Monitor for psychological side effects, which may be more common in children and adolescents than adults 3, 1
Management of Side Effects
- Small nocturnal dose increments can effectively reduce gastrointestinal intolerance and postural hypotension 3, 1
- If psychological side effects occur, dose reduction or medication change may be necessary 3
- For patients who develop intolerance to cabergoline, alternative treatments such as surgery or radiotherapy should be considered 3, 1
- If cerebrospinal fluid leak occurs (confirmed by detection of β2-transferrin or β-trace protein in nasal secretions), urgent intervention may be required, with or without temporary cessation of cabergoline therapy 3
Comparison to Other Dopamine Agonists
- Cabergoline has a better side effect profile than bromocriptine (52% vs 72% adverse events) 1, 5
- Most patients intolerant of other ergot derivatives can tolerate cabergoline 5
- The long half-life of cabergoline (approximately 68 hours) allows for less frequent dosing but may prolong the duration of adverse effects when they occur 5, 6