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Dopamine Agonist — Hyperprolactinaemia / OHSS Pregnancy: Stop when pregnancy confirmed (hyperprolactinaemia); OHSS prevention use ends before implantation

Cabergoline (Hyperprolactinaemia / OHSS Prevention)

Brand names: Dostinex

Adult dose

Dose: Hyperprolactinaemia: 0.5 mg twice weekly. OHSS prevention: 0.5 mg/day for 8 days starting day of hCG trigger
Route: Oral
Frequency: Twice weekly (hyperprolactinaemia); once daily (OHSS prevention)
Max: 3 mg/week (hyperprolactinaemia)
OHSS prevention: cabergoline 0.5 mg/day for 8 days from oocyte trigger day reduces vascular permeability (anti-VEGF mechanism) — reduces moderate OHSS without affecting IVF outcomes

Paediatric dose

Dose: Not applicable N/A/kg
Route: N/A
Frequency: N/A
Max: N/A
Not applicable

Dose adjustments

Renal

No dose adjustment required

Hepatic

Reduce dose in severe hepatic impairment

Paediatric weight-based calculator

Not applicable

Clinical pearls

  • MHRA: Dopamine agonists (cabergoline, bromocriptine) associated with impulse control disorders — warn patients about compulsive behaviours (gambling, hypersexuality, binge eating); review at each visit
  • OHSS prevention mechanism: cabergoline reduces VEGF receptor-2 phosphorylation, reducing vascular hyperpermeability that causes OHSS — evidence supports use in high-risk IVF cycles
  • Preferred over bromocriptine for hyperprolactinaemia: twice-weekly dosing, better tolerability, and more potent prolactin suppression — fewer GI side effects
  • Cardiac valvulopathy: occurs at high cumulative doses (Parkinson's doses); at standard prolactin doses, echocardiography not routinely required but review if symptoms
  • Lactation suppression: cabergoline 0.25 mg twice daily for 2 days is licensed for lactation suppression in contraindicated scenarios (not routinely recommended — physiological suppression preferred)

Contraindications

  • Uncontrolled hypertension
  • Cardiac valvular disease (with long-term high doses — fibrosis risk)
  • Pre-eclampsia or postpartum hypertension (for lactation suppression)

Side effects

  • Nausea
  • Dizziness and headache
  • Postural hypotension
  • Fatigue
  • Cardiac valve fibrosis (high-dose, long-term — MHRA monitoring advice)
  • Impulse control disorders (gambling, hypersexuality — class effect of dopamine agonists)

Interactions

  • Other dopamine agonists (additive)
  • Antihypertensives (enhanced hypotension)
  • Antipsychotics (antagonise dopamine agonist effect)

Monitoring

  • Serum prolactin (response monitoring)
  • Blood pressure
  • Cardiac symptoms (long-term high dose)
  • Impulse control behaviour assessment

Reference: BNFc; BNF 90; MHRA Drug Safety Update (dopamine agonists); RCOG Green-top 5 (OHSS 2016); Alvarez et al. (cabergoline OHSS prevention). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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