Cabergoline

About Cabergoline

Cabergoline is a long-acting dopamine receptor agonist derived from ergot. Dopamine is the body’s natural brake on prolactin, so cabergoline brings down prolactin that is too high, whether from a prolactin-secreting pituitary adenoma or with no cause found. The label starts at 0.25 mg twice a week, half a tablet, and raises the dose by 0.25 mg twice a week no faster than every four weeks, guided by prolactin blood tests, to at most 1 mg twice a week. If it is stopped later, prolactin is checked periodically in case it needs restarting.

Nausea, headache, dizziness, constipation, tiredness and a drop in blood pressure on standing are common. The serious warning is on the heart valves: cabergoline can cause valve leaflets to thicken and leak, and fibrosis of the lining of the lungs, the sac around the heart or the back of the abdomen. Most cases were at doses above 2 mg a day used for Parkinson’s disease, but some occurred at prolactin doses, so the label calls for an echocardiogram before starting and every six to twelve months during treatment, and for stopping if a valve problem or fibrosis appears. It must not be used with uncontrolled high blood pressure, an existing valve disorder, a history of these fibrotic conditions, or an allergy to ergot medicines.

The label says to avoid using it to stop milk production after childbirth, because strokes, seizures, heart attacks and deaths have been reported when a related dopamine agonist was used that way. Some people develop gambling, spending or sexual urges they cannot control, which settle when the dose is reduced or the drug stopped. It is not recommended in severe liver impairment.

Taking Cabergoline

How to take it

Twice a week, with or without food, on the days the prescriber sets. Treatment usually starts at half a tablet (0.25 mg) twice a week and is raised no faster than every four weeks, guided by prolactin tests, to at most 1 mg twice a week.

If you miss a dose

Take it as soon as you remember. If it is almost time for the next dose, skip the missed dose. Do not take a double dose.

Storage

At room temperature in the original container, tightly closed, out of reach of children.

Interactions to know about

It is not recommended with medicines that block dopamine, such as metoclopramide and the phenothiazine, butyrophenone and thioxanthene antipsychotics, which work against it. It can lower blood pressure, especially on standing, so get up slowly. Report breathlessness, a persistent cough, chest or flank pain, leg swelling, and any new urges to gamble, spend or have sex. Tell the prescriber if you become pregnant.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Cabergoline differs from pharmacy to pharmacy

Cabergoline is generic with many makers, but it is not a high-volume drug and comes in small bottles, often of eight tablets, so many pharmacies price it by the tablet rather than from a flat-price list. The dose is one to four tablets a week, so a month’s supply is a handful of tablets, and quotes for the same count differ widely with each pharmacy’s markup and dispensing fee. Echocardiograms and prolactin tests are separate costs.

Ways to pay less for Cabergoline without insurance

• Ask the pharmacy to quote the exact number of tablets your dose needs for a month; with twice-weekly dosing that is usually eight or fewer.
• Once the dose is settled, ask for a prescription covering several months; the label changes the dose no faster than every four weeks.
• Compare quotes from more than one pharmacy; a low-volume generic is priced very differently from place to place.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Cabergoline

1. 1.Which two days a week should I take it, and does food matter?
2. 2.When is my next prolactin test, and when is the echocardiogram due?
3. 3.Which symptoms, such as breathlessness, chest pain or swollen legs, mean I should call?
4. 4.Does it interact with my nausea or mental health medicines?
5. 5.What should I do if I become pregnant?

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