Is it okay to skip one dose of Dostinex (cabergoline) while taking Primolut (norethisterone)?

Skipping One Dose of Dostinex While Taking Primolut

Yes, it is safe to skip one dose of Dostinex (cabergoline) while taking a 10-day course of Primolut (norethisterone), as cabergoline has an extremely long half-life with prolactin-lowering effects lasting up to 14-21 days after a single dose, and there are no known significant drug interactions between these medications. 1, 2

Pharmacokinetic Rationale

• Cabergoline is a long-acting dopamine agonist with prolactin-lowering effects that persist for 14 days in hyperprolactinemic patients and up to 21 days in puerperal women after a single dose 1
• The standard dosing schedule for cabergoline is typically 0.25-2 mg once or twice weekly, demonstrating that the medication does not require daily administration to maintain therapeutic effect 3, 2
• Missing a single dose will not result in immediate loss of prolactin control given the drug's extended duration of action 1, 2

Absence of Drug Interactions

• There are no documented interactions between cabergoline (a dopamine D2 receptor agonist) and norethisterone (a progestogen) in the medical literature 1
• Norethisterone works through progesterone receptors and does not affect dopaminergic pathways, making pharmacologic interaction unlikely 1
• The 10-day duration of Primolut treatment is relatively short and should not interfere with cabergoline's therapeutic effects 2

Practical Management Approach

• If the missed dose falls within your regular weekly schedule, you can either skip it entirely or take it after completing the Primolut course, depending on your usual dosing interval 3, 2
• For patients on twice-weekly cabergoline dosing, missing one dose represents only a brief interruption that is unlikely to cause prolactin rebound given the drug's pharmacokinetics 1, 2
• Resume your regular cabergoline schedule after the Primolut course is completed 3

Important Caveats

• If you are taking cabergoline for a macroprolactinoma with visual symptoms, consult your endocrinologist before skipping doses, as consistent prolactin suppression may be more critical in these cases 3
• Do not attempt to "double up" on cabergoline doses to compensate for the missed dose, as this increases the risk of side effects without additional benefit 3
• Small nocturnal dose increments and consistent dosing schedules help reduce gastrointestinal intolerance and postural hypotension when resuming treatment 3