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Dopamine Agonist (D2 Receptor) / Prolactin Inhibitor Pregnancy: Stop when pregnancy confirmed — limited data. No evidence of teratogenicity from published pregnancies in women who conceived on cabergoline. Discuss risk-benefit with specialist if macroprolactinoma.

Cabergoline

Brand names: Dostinex

Adult dose

Dose: Hyperprolactinaemia / prolactinoma: 500 micrograms (0.5mg) once weekly initially; increase by 500 micrograms every 4 weeks based on prolactin level; usual maintenance 1–2mg weekly (in 1–2 divided doses). Suppression of lactation: 1mg as single dose on day 1 postpartum.
Route: Oral
Frequency: Once or twice weekly (hyperprolactinaemia); single dose (lactation suppression)
Max: 4.5mg per week (prolactinoma — higher doses used in specialist centres)
First-line treatment for macroprolactinomas and symptomatic hyperprolactinaemia. Reduces prolactin levels and shrinks tumour in majority of patients. Take with food to reduce nausea. Cardiac echocardiography recommended if cumulative dose >2mg/week for >6 months (valvulopathy risk — though mainly at Parkinson's doses).

Paediatric dose

Route: Oral
Frequency: Weekly
Max: Individualised
Used in adolescents with prolactinomas under specialist paediatric endocrinology supervision. No specific paediatric dose in BNFc — doses extrapolated from adult data. Seek specialist opinion.

Dose adjustments

Renal

No specific dose adjustment required — minimal renal excretion.

Hepatic

Severe hepatic impairment: reduce dose — extensively hepatically metabolised; accumulation risk.

Clinical pearls

  • First-line for prolactinomas — ~80% of patients achieve normalisation of prolactin and tumour shrinkage with cabergoline; surgery reserved for resistance or intolerance
  • Impulse control disorders: ask specifically about gambling, hypersexuality, binge eating at each review — class effect of dopamine agonists; reduce dose or switch if present
  • Pregnancy: stop cabergoline when pregnancy confirmed (prolactin normally rises in pregnancy); monitor for tumour expansion if macroprolactinoma
  • Echocardiogram: not routinely required at prolactinoma doses (<3mg/week) but recommended if high cumulative dose — MHRA guidance

Contraindications

  • Hypersensitivity to cabergoline or ergot alkaloids
  • Cardiac valvulopathy
  • Uncontrolled hypertension
  • History of pulmonary, pericardial, or retroperitoneal fibrotic disorders

Side effects

  • Nausea (common — take with food)
  • Headache
  • Dizziness / orthostatic hypotension (especially first dose)
  • Fatigue
  • Constipation
  • Impulse control disorders (gambling, hypersexuality — class dopamine agonist effect)
  • Cardiac valve fibrosis (at high cumulative doses — Parkinson's doses; rare at prolactinoma doses)
  • Pleuropulmonary fibrosis (rare, high doses)

Interactions

  • Antipsychotics, metoclopramide, domperidone — antagonise dopaminergic effect; reduce cabergoline efficacy
  • Antihypertensives — additive hypotension
  • Macrolide antibiotics (erythromycin) — increase cabergoline plasma levels

Monitoring

  • Serum prolactin (monthly until stable, then every 6 months)
  • MRI pituitary (annually initially; less frequent once stable)
  • Echocardiogram (if high cumulative dose)
  • Visual fields (if macroprolactinoma — optic chiasm compression)

Reference: BNFc; BNF 90; Endocrine Society Prolactinoma Guidelines 2011; MHRA Cabergoline Safety Update. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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