Cabergoline (Hyperprolactinaemia / OHSS Prevention)

How it works

It is a potent, selective dopamine D2 receptor agonist that suppresses pituitary prolactin secretion; in OHSS prevention it reduces vascular endothelial growth factor-mediated capillary permeability.

Prescribing in practice

• Long-term higher-dose use for prolactinoma has been associated with cardiac valve fibrosis, so echocardiographic surveillance is advised for prolonged therapy, whereas short OHSS-prevention courses carry far lower fibrotic risk.
• Postural hypotension can occur at initiation, and impulse-control disorders are a recognised dopamine-agonist effect requiring counselling.
• Restored fertility and pregnancy planning should be addressed, and concomitant dopamine antagonists reduce efficacy.

Monitoring

Monitor prolactin and symptoms, blood pressure, and cardiac valves by echocardiography during prolonged higher-dose treatment.

Counselling the patient

• Rise slowly initially to avoid dizziness, and report breathlessness, swollen ankles or persistent headache.
• Tell your clinician about any new gambling, shopping or other impulsive urges.
• Discuss contraception or pregnancy plans as fertility may return.

Evidence & guidelines

Cabergoline is a preferred dopamine agonist for hyperprolactinaemia and is supported by evidence for reducing OHSS incidence in assisted reproduction.