Drug Insight: cabergoline and bromocriptine in the treatment of hyperprolactinemia in men and women Nature Reviews Endocrinology

A 44-year-old lady was referred to the neurology clinic because of head and neck pain. On listing her comorbidities and medications, she particularly mentioned cabergoline, which she had taken for 12years for hyperprolactinaemia, initially at a dose of 0.5 mg once weekly between 2001 and 2005, which was then increased to 3 mg once weekly. The patient said, ‘I hate that one, it makes me eat funny’. When asked to elaborate, she explained that she compulsively ate ‘Jamaican bread’ – a high-carbohydrate sweet food.

Dilation and evacuation was completed in the outpatient gynecology clinic or ambulatory surgical center, depending on patient preference and medical considerations. All participants received misoprostol 400 micrograms buccally 120 minutes before the procedure. Those seeking medical abortion and those with fetal death at more than 24 weeks of gestation were admitted to the labor and delivery unit, where they received repeat doses of misoprostol until fetal expulsion occurred. Because of maternal risks, routine prescription of bromocriptine to stop lactation is not indicated.

How to use Cabergoline

Talk with your doctor if you start having problems with gambling or increased sex drive while using this medicine. This medicine may increase your risk of having serious heart, kidney, lung, or stomach problems. Check with your https://otenergy.ca/2023/12/26/new-study-reveals-startling-health-effects-of/ doctor right away if you have chest pain or tightness, extreme tiredness, lower back or side pain, lump or tenderness in the stomach, persistent cough, troubled breathing, or swelling in your hands, ankles, lower legs, or feet.

• Cabergoline is used to treat hyperprolactinemia (high levels of prolactin in your body).
• However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving cabergoline.
• You and your doctor should discuss whether you should continue to take this medicine during pregnancy.
• In a compilation of 14 prospective studies of effects of cabergoline treatment in patients with hyperprolactinemic disorders, the hormonal response rate was 73–96% and tumor size reduction rate between 50% and 100% [19].

The initial focus was on patients with Parkinson’s disease, who usually receive high doses of dopamine agonists (21). However, ICD has been also identified in patients with prolactinoma, who often need lower doses of this class of medications. Such disorders can lead to personal, professional, and financial losses for these patients. They are frequently underdiagnosed by their endocrinologists or general practitioners.

CABERGOLINE tablet

We present the case of a patient treated for hyperprolactinaemia with weekly doses of cabergoline for 12years. Over this time she had suffered from binge eating and compulsive shopping which impacted on her weight and made her finances precarious. We discuss the features of impulse control disorders and suggest that seeking out these side effects in patients taking such agents is important. The behaviours may be embarrassing and patients may not volunteer them, likewise if the doctor dismisses them they may continue unabated, causing significant social harm.

• This is not a complete list of side effects and others may occur.
• Cabergoline was generally well tolerated in the studies noted previously.
• If you have questions about side effects, call your doctor.
• We planned to recruit eight patients, anticipating 25% loss to follow-up and missing data.
• You may need blood work done while you are taking this medicine.

About 80–90% of patients who respond to cabergoline do so rapidly (within 3 months), at low doses (less than 2.0 mg/week), and with good tolerability [223,226]. However, some patients require higher doses, and about 10–15% of patients respond to each dose increase with a step-wise reduction in their PRL levels. Thus, cabergoline is certainly the most effective compound to treat prolactinomas, also offering good patient compliance with long-term treatment regimens. There are several possible approaches for treatment of patients who are resistant to dopamine agonists. Patients taking bromocriptine should simply be converted to cabergoline, because most will then respond (1).

It is used to treat hyperprolactinemic disorders and Parkinsonian Syndrome. Cabergoline possesses potent agonist activity on dopamine D2 receptors. The major problem clinically is the patient with primary dopamine resistance. In other cases, the cause of this secondary lack of response is not known. Prolactinoma patients on dopamine agonists do not usually voice behavior changes to their physicians, nor do they even realize what is happening. Therefore, it is extremely important to proactively investigate impulsivity symptoms, given the relevant evidence of the correlation between such symptoms and dopamine agonists use.

This is not a complete list of side effects and others may occur. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

a. Cardiac Valvulopathy

Adverse effects, particularly nausea, headaches, and dizziness, occurred with both agents but were less frequent, less severe, and of shorter duration with cabergoline. In patients with pituitary adenoma who had been unsuccessfully treated previously with bromocriptine, cabergoline has been found to be effective (Table 37.1). Prolactinomas are the most common functional pituitary adenomas, representing 60% of all clinically evident pituitary tumors (1).

Cabergoline dosing information

We also emphasize the importance of interdisciplinarity, given that in the current case the psychiatric work-up helped identify symptoms that had not been detect during the regular clinical examination. 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 response should be used and other therapeutic approaches considered. This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at FDA-1088.