Can Cabergoline Cause Hair Loss?
Yes, cabergoline can cause hair loss (alopecia), though this is a rare side effect that has been documented in post-marketing surveillance and case reports.
Evidence from FDA Drug Labeling
The FDA-approved prescribing information for cabergoline explicitly lists alopecia as a reported adverse event in post-marketing surveillance 1. While not observed in the initial controlled clinical trials at standard doses for hyperprolactinemia, cases of alopecia have been documented in real-world use 1.
Clinical Evidence and Case Reports
A documented case report from 2003 describes a female patient with Parkinson's disease who developed hair loss specifically after starting cabergoline, with hair regrowth occurring after dose reduction, establishing a clear causal relationship 2.
This case report also notes that hair loss has been reported with various dopaminergic drugs including levodopa and all types of dopamine receptor agonists, suggesting this may be a class effect of dopaminergic medications 2.
The pathophysiological mechanism underlying dopamine agonist-induced hair loss remains unclear, but the temporal relationship and reversibility with dose reduction support causality 2.
Context and Frequency
Hair loss from cabergoline appears to be rare, as it was not detected in the initial controlled trials involving approximately 1,200 patients with Parkinson's disease at doses up to 11.5 mg/day (far exceeding the 2 mg/week typically used for hyperprolactinemia) 1.
The incidence is likely underreported, as patients may not spontaneously report hair loss, and physicians may not routinely inquire about this side effect 2.
Clinical Management
If hair loss occurs with cabergoline, dose reduction should be attempted first, as this has been shown to result in hair regrowth 2.
If dose reduction is not feasible due to inadequate control of hyperprolactinemia, consider switching to an alternative dopamine agonist, though cross-reactivity may occur since hair loss has been reported with other dopamine agonists as well 2.
Complete discontinuation of cabergoline typically leads to full hair regrowth, similar to patterns seen with other medications causing alopecia 3.
Important Caveats
Before attributing hair loss to cabergoline, exclude other common causes of telogen effluvium including fever, severe illness, stress, hemorrhage, and childbirth, as these can confound the temporal association 4.
The hair loss associated with dopamine agonists is generally reversible and should not be confused with permanent scarring alopecias 2.