Cabergoline for men & women: Dostinex (Know Your Medicine)

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Cardiac failure: cases of valvular and pericardial fibrosis have often manifested as cardiac failure. Therefore, valvular fibrosis (and constrictive pericarditis) should be excluded if such symptoms occur. serious chest complaint (e.g. pain in the chest when breathing, fluid in the lungs, inflammation or infection of the lungs). Due to the long half-life of the drug and limited data on in utero exposure, women planning to become pregnant should discontinue cabergoline one month before intended conception. If conception occurs during therapy, treatment should be discontinued as soon as pregnancy is confirmed to limit foetal exposure to the drug.

Treatment with medicines like cabergoline can sometimes cause problems with impulsive types of behaviour. If you notice any changes in your behaviour, such as an increased desire to gamble, binge eat, or spend excessively, or an increased sex drive, you must let your doctor know as soon as possible. Cabergoline is a long-acting medication, usually taken once or twice a week. Cabergoline can make you feel a bit dizzy, or cause nausea or headaches. Side-effects may be reduced if you take the cabergoline with food, or last thing at night before going to bed. Usually your specialist will recommend a low starting dose to reduce the risk of side-effects, gradually increasing the dose if necessary as your body gets used to the medication. Rare side-effects of cabergoline Raynaud’s disease (When it is cold the fingers and toes become bluish white, with no pulse, cold, insensitive and numb)Cabergoline takes many days to be cleared from the bloodstream and effects may worsen over a 2 week period resulting in worsening of symptoms of Parkinson's di­sease. Each amber glass bottle contains 20 tablets and a silica gel desiccant sealed with an aluminium membrane and a child-resistant screw cap. For suppression of established lactation the recommended therapeutic dosage regimen is 0.25 mg (one-half 0.5 mg tablet) every 12 hours for two days (1 mg total dose). This dosage regimen has been demonstrated to be better tolerated than the single dose regimen in women electing to suppress lactation having a lower incidence of adverse events, in particular of hypotensive symptoms. All patients must undergo a cardiovascular evaluation, including echocardiogram to assess the potential presence of asymptomatic valvular disease. Also perform baseline investigations of erythrocyte sedimentation rate or other inflammatory markers, lung function/chest X-ray, serum creatinine and renal function prior to initiation of therapy. If fibrotic valvular disease is detected, the patient should not be treated with cabergoline. The concomitant use of antiparkinson non-dopamine agonists (e.g. selegiline, amantadine, biperiden, trihexyphenidyl) was allowed in clinical studies for patients receiving cabergoline. In studies where the pharmacokinetic interactions of cabergoline with L-dopa or selegiline were evaluated, no interactions were observed.

Cabergoline generally exerts a hypotensive effect in patients on long-term treatment; Postural hypotension, hot flushes** Cabergoline is a tablet treatment used to reduce the production of a hormone called prolactin by the pituitary gland (a gland at the base of the brain). If you have a prolactinoma (overproduction of prolactin by a cluster of cells in the pituitary), cabergoline treatment is also used to shrink the size of the swelling on the pituitary gland. How should I take cabergoline? There were maternotoxic effects but no teratogenic effects in mice given cabergoline at doses up to 8 mg/kg/day (approximately 55 times the maximum recommended human dose) during the period of organogenesis. Try to take cabergoline at the same time(s) of day each day; if you are taking it weekly, take it on the same day of the week each week.There are other medicines such as other ergot alkaloids, medicines to prevent vomiting (metoclopramide), and macrolide antibiotics (such as erythromycin) that may affect the activity and tolerability of Cabergoline. There are some much rarer side-effects of cabergoline. Very rare cases of heart valve damage have been reported. Usually your doctor will listen to your heart before starting cabergoline treatment, and they may arrange an echocardiogram heart scan. This scan may be repeated if you need long-term treatment. It is very unusual for cabergoline to cause clinically significant heart problems, but you should alert your doctor if you developed shortness of breath or ankle swelling. Before you are given Cabergoline your doctor will arrange for you to have tests to assess the condition of your heart. Your doctor will continue to monitor your medical condition while taking Cabergoline. If you are a woman, you may want to discuss what forms of contraception are suitable for you. Hormonal forms of contraception (such as 'the pill') may not be suitable while you are taking cabergoline. You should avoid becoming pregnant during treatment with cabergoline and for one month after stopping. The pharmacodynamic effects of cabergoline have been studied in healthy volunteers, puerperal women and hyperprolactinaemic patients. After a single oral administration of cabergoline (0.3 - 1.5 mg), a significant decrease in serum PRL levels was observed in each of the populations studied. The effect is prompt (within 3 hours from administration) and persistent (up to 7 - 28 days in healthy volunteers and hyperprolactinaemic patients, and up to 14 - 21 days in puerperal women). The PRL-lowering effect is dose-related both in terms of degree of effect and duration of action.

The dose is determined by your doctor who adjusts it individually for you. The recommended dose at the start of treatment is 0.5 –1 mg cabergoline daily. The dose is then increased gradually as directed by the doctor up to a suitable maintenance dose.Your endocrinologist will measure the levels of prolactin in blood tests. They may also repeat your pituitary MRI scan once you have been treated for a while. To reduce the risk of developing the rare side-effects of cabergoline treatment, your endocrinologist will usually recommend the lowest effective dose. Some patients go into remission after a couple of years of treatment and the cabergoline can be stopped: blood tests and scans will enable your specialist to monitor for any recurrence. What about pregnancy? Postural hypotension can occur following administration of cabergoline, particularly during the first days of administration of cabergoline. Care should be exercised when administering cabergoline concomitantly with other drugs known to lower blood pressure. Cabergoline has been associated with somnolence. Dopamine agonists can be associated with sudden sleep onset episodes in patients with Parkinson's disease. Sudden onset of sleep during daily activities, in some cases without awareness or warning signs, has been reported uncommonly. Patients must be informed of this and advised to exercise caution while driving or operating machines during treatment with cabergoline. Patients who have experienced somnolence and/or an episode of sudden sleep onset must refrain from driving or operating machines. Furthermore a reduction in dosage or termination of therapy may be considered. (See section 4.7) The recommended therapeutic dosage is 2 mg to 3 mg/day for patients with signs and symptoms of Parkinson's disease. Cabergoline should be given as a single daily dose. Cabergoline should only be used during pregnancy if clearly indicated and after an accurate benefit/risk evaluation.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.