Download Barnsley Area Prescribing Committee

Amber with Guidance= To be initiated and titrated to a stable dose in secondary care with follow up prescribing and
monitoring by primary care where deemed appropriate.
Drug name: Cabergoline for hyperprolactinaemic disorders
Background
Information
Cabergoline is indicated for the treatment of hyperprolactinaemic disorders.
Cabergoline is a dopaminergic ergoline derivative endowed with a potent and longlasting prolactin-lowering activity. It acts by direct stimulation of the D 2-dopamine
receptors on pituitary lactotrophs, thus inhibiting prolactin secretion.
BNF therapeutic
class
Indication
6.7 Other Endocrine Drugs
Dosage and
administration
Initial dose:
 500micrograms (orally) weekly (either as a stat dose or 250micrograms on
two separate days)
Hyperprolactinaemic disorders, acromegaly, Cushing and pituitary tumours
Maintenance dose:
 Increase at monthly intervals in steps of 500 micrograms until optimal
therapeutic response is achieved – usual maintenance dose is 0.25-2
milligrams weekly
 If doses above 1mg to be used weekly, give in divided doses
 If intolerance is suspected, reduce dose and increase more gradually
Cautions and
Contraindication
Cautioned use in:
 History of peptic ulcers (withdraw cabergoline if GI bleed occurs)
 Raynaud's syndrome
 Cardiovascular disease
 Concomitant use with psychoactive medication and /or history of mental
health disorders
 Acute Porphyria
 Concomitant use with antihypertensives due to risk of postural hypotension
post dose
Contraindication:
 Hypersensitivity to cabergoline or any ergot alkaloid
 Patients with cardiac valvulopathy
 History of pulmonary, pericardial and retroperitoneal fibrotic disorders
 Avoid in pre-eclampsia
 History of puerperal psychosis in women
Adverse Drug
Reactions
Very Common:
 nausea, abdominal and gastric pain constipation and headache
Reported:
 Hypotension, drowsiness, dyskinesia, impulse control disorders, leg cramps
 Dyspepsia, gastritis and vomiting
 Angina, syncope and depression
 Peripheral oedema
 Pleuritis and pleural effusion
 signs of impulse control disorders i.e pathological gambling, increased libido,
hyper sexuality, compulsive spending or buying, binge and compulsive eating
Cabergoline Guidance
Rarely:
 Paraesthesia, palpitations, epistaxis, digital vasospasm, transient hemianopia
Page 1 of 2
Date Prepared: October 2015
Review Date: October 2017
Amber with Guidance= To be initiated and titrated to a stable dose in secondary care with follow up prescribing and
monitoring by primary care where deemed appropriate.
Monitoring
and muscle weakness
Initiation and baseline monitoring to be done by the specialist. GP to continue
prescribing therapy and be aware of the following:
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Interactions
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Monitoring of prolactin levels will be done according to clinical requirements
and dose adjusted as required
A baseline ECHO will be performed at initiation of therapy with any clinical
issues highlighted being used to determine further monitoring and use
Monitoring for signs of pituitary enlargement is only necessary when a
prolactinoma has been diagnosed.
Pregnancy:
Cabergoline to be stopped once a positive pregnancy test has been achieved
Mechanical contraception should only be used if fertility is not the therapy
endpoint.
A smear test will be done as recommended by the public health cervical
cancer screening programme. No further gynaecological input Is required for
cabergoline use in Hyperprolactinaemia
Not recommended for use with other ergot alkaloids
Avoid concomitant use with droperidol, prochloperazine, benperidol,
haloperidol, flupentixol, zuclopentixol and metoclopramide
Avoid with macrolide antibiotics due to increased systemic bioavailability of
cabergoline
Contact names and details
Contact Details
Telephone number
Email
Professor Hugh Jones, Consultant Physician &
Endocrinologist
Chris Lawson, Head of Medicines management,
NHS Barnsley CCG
Gillian Turrell, Lead Pharmacist Medicines
Information / Cardiology, BHNFT
01226 431896
[email protected]
01266 733798
[email protected]
01226 432857
[email protected]
References
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British National Formulary. March 2015. Available at www.bnf.org Accessed: 20.08.2015
Cabergoline (Dostinex). Summary of Product Characteristics. December 2013. Available at
http://www.medicines.org.uk/emc/medicine/10003#PHARMACODYNAMIC_PROPS. Accessed on
20/08/2015
Development Process
This guideline was developed following an AMBER-G (Amber with guidance) classification status of cabergoline
for the treatment of hyperprolactinaemic disorders, by the Barnsley Area Prescribing Committee. This
information has been subject to consultation and endorsement by the Endocrinologists in Barnsley and was
ratified at the Area Prescribing Committee on 14th October 2015and the LMC on 10th November 2015.
Cabergoline Guidance
Date Prepared: October 2015
Page 2 of 2
Review Date: October 2017