Usual Dose of Cabergoline
The standard initial dose of cabergoline is 0.25 mg twice weekly, with gradual titration up to 1-2 mg per week for most patients with hyperprolactinemia. 1
Initial Dosing
- Start with 0.25 mg twice weekly (0.5 mg total per week) for initiation of therapy 1, 2
- This low starting dose minimizes gastrointestinal intolerance and postural hypotension 2
Dose Titration
- Increase by 0.25 mg twice weekly (0.5 mg total per week increments) based on serum prolactin levels 1
- Do not increase dosage more rapidly than every 4 weeks to allow adequate assessment of response at each dose level 1
- The typical therapeutic range is 1-2 mg per week for most patients with prolactinomas 2, 1
Standard Maintenance Dosing
- For microprolactinomas or idiopathic hyperprolactinemia: 0.5-1 mg per week is often sufficient 3
- For macroprolactinomas: 1-2 mg per week is typically required 3
- The FDA-approved maximum is 1 mg twice weekly (2 mg total per week) 1
Higher Doses for Resistant Cases
- For dopamine agonist resistance: graduated dose increments up to 3.5 mg per week can be offered 2
- In exceptional cases: doses up to 7 mg per week may be used, though evidence for additional benefit above 3.5 mg/week is limited 2
- Resistance is defined as failure to normalize prolactin and/or achieve <50% tumor reduction after 3-6 months at maximally tolerated doses (at least 2 mg/week) 2
Cardiac Monitoring Requirements
- Baseline echocardiogram should be obtained before initiating treatment 1, 4
- For doses >2 mg per week: annual echocardiography with cardiac auscultation is required 4, 2
- For doses ≤2 mg per week: echocardiographic surveillance every 5 years 4, 2
Dose Reduction and Discontinuation
- After serum prolactin normalizes for 6 months, cabergoline may be discontinued with periodic monitoring 1
- Once adequate control is achieved, the dose can often be reduced by 50% while maintaining efficacy 3