Cabergoline Lancashire and South Cumbria Medicines Management Group

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A dose of 0.012 mg/kg/day (approximately 1/7 the maximum recommended human dose) during the period of organogenesis in rats caused an increase in post-implantation embryofoetal losses. These losses could be due to the prolactin inhibitory properties of cabergoline in rats. At daily doses of 0.5 mg/kg/day (approximately 19 times the maximum recommended human dose) during the period of organogenesis in the rabbit, cabergoline caused maternotoxicity characterized by a loss of body weight and decreased food consumption.

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However, her cardiac enzymes were mildly elevated with creatinine kinase 317 U/L (24–173) and troponin T 0.18 ug/L (0–0.10). Treatment of hyperprolactinaemic disorders Initially, 500 micrograms per week given in either one dose, or as two doses on separate days e.g. on Mondays and Thursdays. A further use of cabergoline is to reduce prolactin production from a type of tumour of the pituitary gland, called a prolactinoma. Dostinex tablets contain the active ingredient cabergoline, which is a type of medicine called a dopamine agonist.

• The D2 receptor is the predominant DR subtype in pituitary gland [9,10].
• Doses of up to 4.5 mg weekly have been used in hyperprolactinaemic patients, however the maximum dose is 3 mg per day.
• Schaefer (2007) concludes that continuing treatment is not grounds for termination or invasive diagnostic procedure.
• Ovulation induction and assisted reproductive therapy may be given as necessary to facilitate pregnancy.
• Occasionally, the medications may cause slight constipation, but this can usually be cured by increasing the amount of fibre in your diet.

On the third day of admission, she experienced dyspnoea, orthopnoea and cough. Physical examination revealed normal BP, sinus tachycardia (110 beats per minute), raised jugular venous pressure, lung crackles on chest auscultation and bilateral pedal oedema. An electrocardiogram (ECG) confirmed sinus tachycardia with no ST-segment changes. Routine blood investigations including full blood count, blood sugar, renal profile and liver function tests were all within normal range.

Why has my doctor recommended cabergoline treatment?

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• In view of its long half-life, increases in daily dose of 500 micrograms to 1mg should be made at weekly intervals (initially) or bi-weekly intervals until the optimal dose is reached.
• Cabergoline is a dopaminergic ergoline derivative endowed with a potent and long-lasting PRL-lowering activity.
• Any claims for non-ordered items or non-delivery must be made within 7 days of receiving the invoice.

Cabergoline, a lysergic acid amide derivative, is a potent dopamine D2 receptor agonist. It also acts on dopamine receptors in lactophilic hypothalamus cells to suppress prolactin production in the pituitary gland. Our case illustrates the potential therapeutic benefit of cabergoline, a dopamine-receptor agonist, as an adjunct to facilitate early recovery of left ventricular function in PPCM.

Advise women to use non-hormonal methods of contraception during treatment and for 1 month thereafter. Monitor women who become pregnant to detect sign of pituitary enlargement as pre-existing tumours may expand during gestation. The side effects listed above may not include all of the side effects reported by the medicine’s manufacturer. It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management. Advise women of child-bearing age to use non-hormonal methods of contraception during treatment and for one month thereafter. During dose titration, the dose of concurrent levodopa should be gradually reduced as the dose of cabergoline is increased until the optimum balance is reached.

Inhibition of lactation

If fibrotic valvular disease is detected, the patient should not be treated with cabergoline. Limited data regarding the use of cabergoline during human pregnancy at the lower doses used for hyperprolactinaemia gave no indication of an increased risk of birth defects in over 350 pregnancies that occurred during treatment (Schaefer, 2007). Manufacturers also reports data from 256 pregnancies, 17 pregnancies showed incidence of abortion and congenital abnormality. Musculoskeletal malformations were the most common neonatal abnormality, followed by cardio-pulmonary abnormalities. Before initiating treatmentAll patients must undergo a cardiovascular evaluation, including echocardiogram to assess the potential presence of asymptomatic valvular disease. We advised the patient to reduce her mental stress and planned to perform IUI after additional ovulation induction.

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If you wish to breast feed you should discuss this with your endocrinologist during your pregnancy. Following the birth, you will be reassessed by your endocrinologist regarding the need for further treatment for your Prolactinoma. Fertility may return quite quickly, so if you do not wish to become pregnant, you and your doctor will need to discuss an effective method of contraception, before medication is started.

According to the literature, dopamine agonist resistance is defined as higher than normal serum PRL and/or no tumor shrinkage after dopamine treatment. Up to 25% of patients fail to achieve normal PRL levels after bromocriptine treatment, and 10% to 15% of patients fail to have their PRL levels under control after cabergoline treatment. Nevertheless, one study showed that two cabergoline-resistant prolactinoma patients achieved satisfactory treatment results after bromocriptine treatment [12].