From the Guidelines
Cabergoline dosing for prolactin tumors should not exceed 7 mg per week, with graduated dose increments offered to patients resistant to standard doses, as indicated by the most recent consensus guideline 1. When managing prolactinomas, it's essential to consider the patient's response to standard dopamine agonist doses.
- For patients unresponsive to standard doses (up to 1.5–2 mg of cabergoline per week), higher doses (3.5–7 mg per week) may be effective, as reported in recent studies 1.
- However, doses above 3.5 mg per week may have limited benefit in some adults, and high-dose cabergoline is generally well tolerated, with successful treatment of CYP with prolactinoma reported at doses up to 7 mg per week 1. Key considerations for cabergoline dosing include:
- Starting with a low dose and gradually increasing as needed, based on prolactin levels and symptom response
- Monitoring for side effects, such as nausea, headache, and dizziness, and rare cardiac valve abnormalities at higher doses
- Regular monitoring of prolactin levels and periodic MRI imaging to assess tumor size, as recommended by recent guidelines 1
- Considering adjuvant therapy with surgery or radiotherapy for patients with cabergoline resistance or intolerance, as indicated by the most recent consensus guideline 1.
From the FDA Drug Label
The recommended dosage of cabergoline tablets for initiation of therapy is 0.25 mg twice a week. Dosage may be increased by 0. 25 mg twice weekly up to a dosage of 1 mg twice a week according to the patient's serum prolactin level. The recommended dosing for cabergoline in patients with prolactin tumors is:
- Initial dose: 0.25 mg twice a week
- Maximum dose: 1 mg twice a week
- Dose increase: 0.25 mg twice weekly, with increases not occurring more rapidly than every 4 weeks 2 The treatment duration may be discontinued after a normal serum prolactin level has been maintained for 6 months, with periodic monitoring to determine whether treatment should be reinstituted 2
From the Research
Cabergoline Dosing for Prolactin Tumors
- The initial dose of cabergoline for prolactin-secreting pituitary adenoma is typically 0.25 mg twice a week for 4 weeks, with stepwise increases of 0.5 mg until the lowest maximally effective and tolerated dose is reached 3.
- The effective dose of cabergoline correlates significantly with basal serum prolactin levels and pituitary tumor size 3.
- In a study of 15 patients with macroprolactinomas, cabergoline was administered once per week, with doses ranging from 0.5-3.0 mg per week, resulting in a mean prolactin level decrease of 93.6% and normalization of prolactin levels in 73% of patients 4.
- A comparison of cabergoline and bromocriptine in hyperprolactinemic patients found that cabergoline resulted in a significantly greater reduction in prolactin levels (-93% vs -87.5%) and was better tolerated, with adverse events noted in 12% of cabergoline patients compared to 53% of bromocriptine patients 5.
- In cases of dopamine-agonist resistant macroprolactinomas, combined treatment with cabergoline and octreotide may be effective, as demonstrated in a case report of a patient with a large invasive macroprolactinoma who achieved normalized prolactin levels after 12 months of therapy 6.
- Overall, cabergoline is a highly effective and well-tolerated treatment for hyperprolactinemia in both men and women, with tumor shrinkage and improvement of visual-field defects observed in the majority of patients with macroprolactinomas 7.