Dopamine Agonist (D2 Receptor) / Prolactin Inhibitor Pregnancy: No adequate controlled studies in pregnancy; use only if clearly indicated after benefit/risk evaluation. Exclude pregnancy before treatment and prevent pregnancy for at least one month after. Women planning pregnancy should discontinue one month before intended conception; if conception occurs, discontinue once pregnancy is confirmed. Not to be used by mothers who wish to breast-feed (prevents lactation).

Cabergoline

Brand names: Dostinex

Cabergoline is a long-acting dopamine agonist used for hyperprolactinaemia and prolactinoma, and also in Parkinson's disease. It suppresses prolactin secretion and shrinks prolactin-secreting tumours.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Hyperprolactinaemia: 0.5 mg per week initially; usual therapeutic dose 1 mg/week (range 0.25-2 mg/week)

Route: Oral (preferably with meals)

Frequency: Weekly, given as a single dose or divided into two or more doses per week

Max: Should not exceed 3 mg per day

Treatment of hyperprolactinaemic disorders: initial 0.5 mg/week given in one or two doses; increase gradually, preferably by 0.5 mg/week at monthly intervals, until optimal response. Therapeutic dose usually 1 mg/week (range 0.25-2 mg/week); doses up to 4.5 mg/week have been used. Divide the weekly dose into multiple administrations when higher than 1 mg/week. Monitor serum prolactin monthly. Inhibition of physiological lactation: 1 mg (two 0.5 mg tablets) as a single dose on the first day post-partum. Suppression of established lactation: 0.25 mg every 12 hours for two days (1 mg total). Severe hepatic insufficiency (Child-Pugh C): consider lower doses for prolonged treatment (increased AUC). Cardiovascular/echocardiographic evaluation is advised before and during long-term treatment. Elderly: experience very limited.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION The recommended dosage of Cabergoline Tablets, USP for initiation of therapy is 0.25 mg twice a week. Dosage may be increased by 0.25 mg twice weekly up to a dosage of 1 mg twice a week according to the patient’s serum prolactin level. Before initiating treatment, cardiovascular evaluation should be performed and echocardiography should be considered to assess for valvular disease. Dosage increases should not occur more rapidly than every 4 weeks, so that the physician can assess the patient's response to each dosage level. If the patient does not respond adequately, and no additional benefit is observed with higher doses, the lowest dose that achieved maximal …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-12-08. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to cabergoline, any excipient or any ergot alkaloid
History of pulmonary, pericardial and retroperitoneal fibrotic disorders
Hepatic insufficiency
Toxaemia of pregnancy
Should not be co-administered with antipsychotic medications, or given to women with a history of puerperal psychosis
For long-term treatment: evidence of cardiac valvulopathy on pre-treatment echocardiography

Side effects

Valvulopathy including regurgitation and related disorders (pericarditis, pericardial effusion) (very common)
Headache, dizziness/vertigo (very common)
Nausea, dyspepsia, gastritis, abdominal pain (very common)
Asthenia, fatigue (very common)
Postural hypotension, hot flushes (common); somnolence (common); depression (common)

Interactions

Antipsychotics (D2-antagonists — e.g. phenothiazines, butyrophenones, thioxanthenes, metoclopramide) — do not co-administer
Other ergot alkaloids — caution (as with other ergot derivatives)
Drugs known to lower blood pressure — caution owing to risk of symptomatic/postural hypotension
Concomitant psychoactive medication — particular care required

Clinical monograph

How it works

It is an ergot-derived dopamine D2 receptor agonist; stimulating pituitary dopamine receptors inhibits prolactin release.

Prescribing in practice

Cardiac valve fibrosis is a key risk, particularly with the higher doses used in Parkinson's disease, requiring echocardiographic monitoring.
Impulse-control disorders (e.g. pathological gambling, hypersexuality) and other fibrotic reactions (pulmonary, retroperitoneal) can occur.
Nausea and postural hypotension are common, especially on initiation and dose increases.

Monitoring

Monitor prolactin and clinical response; assess for cardiac, pulmonary and retroperitoneal fibrosis (including echocardiography per current prescribing references) and ask about impulse-control symptoms.

Counselling the patient

Tell your clinician about new urges such as gambling, excessive shopping or changes in sexual behaviour.
Report breathlessness, persistent cough or chest pain.
Rise slowly from sitting or lying to reduce dizziness.

Evidence & guidelines

Established first-line dopamine agonist for hyperprolactinaemia; fibrosis monitoring per the SPC and MHRA advice.

Reference: Endocrine Society Prolactinoma Guidelines 2011; MHRA Cabergoline Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Bromocriptine · Dopamine Agonist (D2 Receptor) / Prolactin Inhibitor

Pathways