Cabergoline

Indications

  1. Prolactin producing pituitary adenomas (first-line).
  2. GH- and TSH- producing pituitary adenomas (as an adjunct).

Dosage

Typical cabergoline dose is 0.5 to 2.0 mg per week, in 2-4 divided doses. E.g., 0.5 mg twice weekly.

Some aggressive/resistant prolactinomas (~ 10-15%) require higher doses.

Tapering

Cabergoline may be tapered and stopped, with careful monitoring, in patients with the following criteria:

  1. Received 2 years of treatment with a dopamine-agonist
  2. Normal serum prolactin.
  3. No visible tumour on MRI.

Pregnancy

  • Once pregnancy is confirmed, discontinue cabergoline therapy. However, you may chose to continue therapy in women with large tumours abutting the optic chiasm.
  • Women taking cabergoline prior to and up to 5 weeks of gestation did not have an increased risk of miscarriage or teratogenicity.

References

  • Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JA; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. JCEM. 2011 Feb;96(2):273-88.
  • Sandret L, Maison P, Chanson P. Place of cabergoline in acromegaly: a meta-analysis. JCEM. 2011 May;96(5):1327-35.