From the Guidelines
Cabergoline use for ovarian hyperstimulation syndrome (OHSS) is associated with potential side effects and risks, including nausea, headache, dizziness, fatigue, and abdominal discomfort, as well as more serious but less common side effects like orthostatic hypotension and mood changes. The typical dosage for OHSS prevention is 0.5 mg once daily for 7-8 days, starting on the day of hCG administration or oocyte retrieval 1. Caution should be exercised in patients with liver disease, uncontrolled hypertension, or history of psychiatric disorders. Cabergoline works by inhibiting prolactin secretion and reducing vascular endothelial growth factor (VEGF), which helps decrease vascular permeability and fluid accumulation characteristic of OHSS.
Some key points to consider when using cabergoline for OHSS include:
- Common side effects: nausea, headache, dizziness, fatigue, and abdominal discomfort
- Less common but more serious side effects: orthostatic hypotension, mood changes, and cardiac valve fibrosis with long-term use
- Typical dosage: 0.5 mg once daily for 7-8 days
- Caution in patients with liver disease, uncontrolled hypertension, or history of psychiatric disorders
- Mechanism of action: inhibition of prolactin secretion and reduction of VEGF
According to the most recent and highest quality study, cabergoline is generally considered safe for short-term use in OHSS management, but patients should report any unusual symptoms promptly to their healthcare provider 1. Additionally, evidence suggests that adult patients with prolactinoma who are unresponsive to standard dopamine agonist doses may respond to higher doses of cabergoline, up to 7 mg per week in exceptional cases 1. However, it is essential to carefully weigh the potential benefits and risks of cabergoline use in each individual patient.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Side Effects or Risks of Cabergoline for OHSS
- The use of cabergoline in preventing ovarian hyperstimulation syndrome (OHSS) has been studied in several trials, with results indicating its effectiveness in reducing the risk of OHSS, especially moderate OHSS 2, 3.
- A study found that oral cabergoline, 0.5 mg daily, given as an intervention, compared with a matched placebo, resulted in a statistically significant reduction in OHSS 3.
- However, there was no significant difference in the clinical pregnancy rate, miscarriage rate, or any other adverse effects of the treatment between the cabergoline and placebo groups 3.
- Another study suggested that high-dose cabergoline (1 mg/day) might prevent an increase in the severity of OHSS and its prolongation following the occurrence of pregnancy 4.
- The pathophysiological mechanisms involved in OHSS show that targeting VEGF/VEGFR2 is an effective preventive approach to treat the syndrome, and pharmaco-prevention through dopamine agonists, such as cabergoline, is effective only in non-pregnant high-risk OHSS women 5.
- A review of 16 RCTs involving 2091 high-risk women found that dopamine agonists, including cabergoline, seemed effective in the prevention of moderate or severe OHSS, but may increase the incidence of adverse events such as gastrointestinal adverse effects 6.
Adverse Effects of Cabergoline
- Gastrointestinal adverse effects, such as nausea and vomiting, have been reported as potential side effects of cabergoline 6.
- There is no evidence of a difference in live birth rate, clinical pregnancy rate, multiple pregnancy rate, or miscarriage rate between cabergoline and other active interventions, such as human albumin, coasting, or prednisolone 6.
- The quality of the evidence between dopamine agonist and placebo or no intervention ranged from very low to moderate, mainly due to poor reporting of study methods and serious imprecision for some comparisons 6.