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

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If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. are allergic to cabergoline, other ergot alkaloids (e.g. bromocriptine), or to any of the other ingredients of this medicine (listed in section 6) Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. Binge eating (eating large amounts of food in a short time period) or compulsive eating (eating more food than normal and more than is needed to satisfy your hunger) Cabergoline generally exerts a hypotensive effect in patients on long-term treatment; Postural hypotension, hot flushes**

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. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine. 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 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. Cabergoline is a dopaminergic ergoline derivative endowed with a potent and long-lasting PRL-lowering activity. It acts by direct stimulation of the D 2-dopamine receptors on pituitary lactotrophs, thus inhibiting PRL secretion. In rats the compound decreases PRL secretion at oral doses of 3-25 mcg/kg, and in-vitro at a concentration of 45 pg/ml. In addition, cabergoline exerts a central dopaminergic effect via D 2 receptor stimulation at oral doses higher than those effective in lowering serum PRL levels. The long lasting PRL-lowering effect of cabergoline is probably due to its long persistence in the target organ as suggested by the slow elimination of total radioactivity from the pituitary after single oral dose in rats (t ½of approximately 60 hours).

will be treated with Cabergoline for a long period and have or had fibrotic reactions (scar tissue) affecting your heart. Before cabergoline administration, pregnancy should be excluded and after treatment pregnancy should be prevented for at least one month. Cabergoline is a long-acting medicine, which only needs to be taken once or twice a week. Your specialist will recommend the appropriate dose for you. Common side-effects of cabergoline

Depending on your prolactinoma, your symptoms and your situation, you may need no treatment at all, or there may be alternatives such as oestrogen or testosterone treatment. If you are not able to tolerate treatment with cabergoline, or if it is not effective in your case, there are similar medications that can be considered, or other treatment options including pituitary surgery. Your endocrinologist will discuss the options with you. Other informationCabergoline can negatively affect the ability to react in some people and this should be considered in cases where a high level of alertness is required, e.g. driving a car and in precision work. 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. Renal insufficiency or ureteral/abdominal vascular obstruction that may occur with pain in the loin/flank, and lower limb oedema, as well as any possible abdominal masses or tenderness that may indicate retroperitoneal fibrosis. 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. 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.

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.

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. Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London. Cabergoline suppresses lactation through its inhibition of prolactin release from the anterior pituitary gland. Therefore, it is not recommended for any woman wishing to breastfeed.