Uses
Hyperprolactinemic Disorders
Treatment of hyperprolactinemic disorders due to prolactinoma (prolactin-secreting adenomas) or idiopathic hyperprolactinemia. Suppresses prolactin secretion, restores gonadal function, and reduces the size of prolactinomas.
At least as effective as bromocriptine in normalizing serum prolactin concentrations and restoring gonadal function in women with hyperprolactinemic amenorrhea. Fewer adverse effects, especially adverse GI effects, reported in cabergoline-treated women than in bromocriptine-treated women. Bromocriptine preferred when restoration of fertility is the goal of therapy; this recommendation is based on the safety record of bromocriptine in pregnant women.
Parkinsonian Syndrome
Has been used for the symptomatic management of parkinsonian syndrome†.
Has been used as monotherapy for initial symptomatic management of parkinsonian syndrome†. Most clinicians would use levodopa for initial therapy in individuals >70 years of age (less likely than younger individuals to develop levodopa-related motor complications and because of concerns about cognitive dysfunction), in patients with cognitive impairment, and in those with severe disease. A dopamine receptor agonist may be preferred for initial therapy in patients ≤70 years of age.
Has been used as an adjunct to levodopa for the symptomatic management of parkinsonian syndrome† in patients with advanced disease.
Dosage and Administration
Administration
Oral Administration
Administer orally without regard to meals.
Hyperprolactinemic disorders: Administer twice weekly.
Parkinsonian syndrome: Administer once daily.
Dosage
Adults
Hyperprolactinemic Disorders
Oral
Initiate at low dosage and increase slowly (at ≥4 week intervals) until therapeutic response is achieved.
Initially, 0.25 mg twice weekly; increase in increments of 0.25 mg twice weekly up to 1 mg twice weekly. Base dosage adjustments on serum prolactin concentrations; use lowest effective dosage.
Consider decreasing the dosage if normal serum prolactin concentrations maintained for 24 months and size of tumor decreased ≥50%; periodically monitor to determine whether retreatment is needed. Some patients (e.g., those with microadenomas) may be able to discontinue the drug; discontinuance in those with macroadenomas should be undertaken with extreme caution. The manufacturer states that efficacy >24 months not established.
Parkinsonian Syndrome
Oral
Initiate at low dosage and increase slowly (at intervals of 7 or 14 days) until the maximum therapeutic response is achieved.†
2–6 mg daily has been used.†
Therapy has been initiated with 1 mg once daily, then increased in increments of 0.5–1 mg at 7 or 14 day intervals until control of symptoms obtained.†
When cabergoline is used as an adjunct to levodopa, the levodopa dosage may be decreased gradually as tolerated.†
When therapy with a dopamine receptor agonist is discontinued, the drug is discontinued gradually.†
Prescribing Limits
Adults
Hyperprolactinemic Disorders
Oral
Dosages >1 mg twice weekly have not been systematically evaluated.
Special Populations
Hepatic Impairment
No specific dosage recommendations at this time; use with caution in patients with severe hepatic impairment. (See Hepatic Impairment under Cautions and also see Absorption: Special Populations, under Pharmacokinetics.)
Renal Impairment
No specific dosage recommendations at this time.(See Elimination: Special Populations, under Pharmacokinetics.)
Geriatric Patients
Select dosage carefully; start at low dosage.(See Geriatric Use under Cautions.)
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