cabergoline: clinical use

Prescribing considerations

• Confirm the cause of hyperprolactinaemia and evaluate the pituitary before treatment.
• Assess cardiovascular, pulmonary, renal, hepatic, gastrointestinal and psychiatric history.
• Counsel that fertility may return before menstruation resumes.
• Discuss somnolence, sudden sleep, postural hypotension and impulse-control disorders.
• For postpartum use, assess pregnancy-related hypertension and monitor for serious neurological, cardiovascular or psychiatric symptoms.

Contraindications and cautions

• Hypersensitivity to cabergoline, an excipient or another ergot alkaloid.
• History of pulmonary, pericardial or retroperitoneal fibrosis.
• Hepatic insufficiency or toxaemia of pregnancy for the selected product.
• Concurrent antipsychotic treatment or a history of puerperal psychosis.
• For long-term treatment, cardiac valvulopathy identified by pre-treatment echocardiography.

Monitoring

• Check prolactin and clinical response; consider repeat pituitary imaging according to the underlying lesion.
• Undertake cardiovascular assessment and echocardiography before long-term treatment, with periodic repeat assessment.
• Monitor for symptoms or findings suggesting fibrotic disease.
• Monitor blood pressure, particularly where postpartum or hypotensive risk is relevant.
• Ask patients and carers about new impulse-control or psychiatric symptoms.

Clinical pharmacology

Cabergoline is a long-acting ergoline derivative that directly stimulates pituitary D2 receptors and inhibits prolactin secretion. It undergoes extensive biotransformation, has a long elimination half-life and is partly protein bound; food does not materially alter its absorption or disposition.

Formulation and product differences

• The selected product is an uncoated, scored oral tablet containing lactose monohydrate. It is supplied in a light-protective bottle with a desiccant that should remain in the container.

Tablet

Route: Oral

Strengths: 0.5 mg, 1 mg, 2 mg