WHAT IS THIS MEDICINE AND
WHAT IS IT USED FOR?
Cabergoline is a medicine that mimics
the effect of dopamine, a brain chemical that naturally suppresses the
production of prolactin, a hormone made by the pituitary gland. When prolactin
levels are too high (a condition called hyperprolactinaemia), it can cause
unwanted breast milk production (in men and women who are not breastfeeding),
missed or irregular periods, reduced sex drive, and infertility.
Prolactin-secreting pituitary tumours (prolactinomas) are the most common cause
of high prolactin. Cabergoline is also prescribed to stop breast milk
production (lactation) after childbirth when a mother chooses not to
breastfeed, or when breastfeeding is medically inadvisable.
3. HOW TO TAKE THIS MEDICINE
For stopping breast milk production
after delivery: Two 0.5 mg tablets (1 mg total) are taken as a SINGLE DOSE on
Day 1 after giving birth. For treating high prolactin/prolactinoma: Start
with 0.5 mg weekly, taken in 1–2 doses on different days of the week (e.g.,
Monday and Thursday). Your doctor will adjust the dose monthly based on
prolactin blood test results. Take with food to reduce nausea. The tablets in
this 8-pack may be used for 2 weeks of weekly therapy or a single
lactation-suppression dose.
|
💡
PATIENT TIP: Liver disease significantly slows cabergoline clearance — dose
reduction is needed for severe hepatic impairment. No specific renal dose
adjustment required. Elderly patients: lower starting doses with cautious
titration due to cardiovascular risk. |
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects to Know About |
|
Common (>1 in 10) |
Nausea (most common —
taking with food helps), headache, dizziness, fatigue, constipation,
abdominal discomfort, hot flushes, postural hypotension (dizziness when
standing up) |
|
Less Common |
Drowsiness, mood changes,
nasal congestion, indigestion, breast pain reduction (intended in lactation
suppression), temporary, slight breast tenderness |
|
Seek Medical Help |
Cardiac valve disease
(fibrotic thickening of heart valves — mainly a risk with high doses used
long-term for Parkinson's disease, but regular monitoring is still advised).
Pulmonary or retroperitoneal fibrosis (scarring of tissues around the lungs
or abdomen). Impulse control disorders (compulsive gambling, hypersexuality,
excessive shopping or eating — particularly in patients on dopamine
agonists). Hallucinations or psychosis (rare). |
5. WHO SHOULD NOT TAKE THIS
MEDICINE
Known allergy to cabergoline or other
ergot-derived medicines. Uncontrolled high blood pressure. Pre-eclampsia or
postpartum high blood pressure (for lactation suppression). Pre-existing heart
valve disease. History of fibrotic conditions (pleuropulmonary or
retroperitoneal fibrosis).
|
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IMPORTANT SAFETY INFORMATION: CARDIAC VALVES: An
echocardiogram (heart ultrasound) should be performed before and during
long-term treatment, especially at higher doses. At standard prolactinoma
doses, cardiac monitoring is still recommended.
IMPULSE CONTROL: Tell your
doctor if you notice unusual urges — compulsive gambling, unusual sexual
behaviour, compulsive shopping. These are recognised side effects that can be
severe.
HYPOTENSION: Risk of
dizziness or fainting, especially at treatment start — rise slowly from
sitting or lying.
DRIVING: May cause sudden
excessive sleepiness — take particular care when driving. |
6. MEDICINES THAT INTERACT
WITH THIS TREATMENT
Antipsychotics (haloperidol,
risperidone, olanzapine) and metoclopramide: block dopamine and counteract
cabergoline — avoid combination or use with extreme caution. Domperidone
(anti-nausea): also reduces cabergoline's effectiveness. Macrolide antibiotics
(erythromycin): may increase cabergoline blood levels. Antihypertensive
medicines: additive blood pressure-lowering effect.
7. HOW TO STORE THIS
MEDICINE
Store below 25°C. Protect from light and
moisture. Keep in original packaging. Keep out of reach of children.
8. PRESCRIPTION REQUIREMENT
|
Status |
Prescription Only Medicine
(POM) |
9. GUIDANCE FOR PATIENTS
& CAREGIVERS
For lactation suppression: take both
tablets (1 mg total) as a single dose on the first day after delivery. For
ongoing prolactin treatment: take the prescribed dose once or twice weekly with
food — your doctor will adjust based on regular blood test results. Rise slowly
when getting up — this medicine can cause dizziness. Report immediately:
unusual urges (excessive gambling, sexual thoughts, or spending), chest pain,
shortness of breath, excessive sleepiness, or vision changes. Keep all
follow-up appointments as prolactin levels and potentially heart function need
monitoring.
10. PHARMACIST &
PRESCRIBER NOTES
|
Clinical Dispensing Notes |
8-tablet pack: 1 mg single
dose (2 tablets) for lactation suppression, or initial weeks of
hyperprolactinaemia therapy. Confirm indication and expected duration.
Counsel on food administration, postural hypotension, and impulse control
monitoring. For ongoing prolactinoma treatment, arrange regular prolactin
blood level monitoring. Echocardiographic monitoring is advised for long-term
higher-dose use. Avoid antidopaminergic drugs concurrently (antipsychotics,
metoclopramide, domperidone). |
11.
FREQUENTLY ASKED QUESTIONS
Q: How does cabergoline stop breast milk
production?
A: Cabergoline mimics dopamine — a brain
chemical that tells the pituitary gland to suppress prolactin production.
Prolactin is the hormone that stimulates milk production. By reducing prolactin
levels, cabergoline prevents milk from being produced.
Q: How quickly does cabergoline work to
stop breast milk?
A: A single 1 mg dose (two 0.5 mg
tablets) taken on the first day after delivery is usually effective in stopping
milk production within a few days. Some mild breast engorgement may still occur, but should resolve.
Q: What are impulse control disorders
and why might cabergoline cause them?
A: Dopamine agonists like cabergoline
can sometimes over-stimulate the brain's reward pathways, leading to compulsive
or uncontrolled behaviours such as excessive gambling, unusually high sexual
urges, compulsive shopping, or overeating. These are recognised side effects —
tell your doctor immediately if you notice any unusual changes in your
behaviour.
Q: Can cabergoline help with fertility?