Cabergoline

Class and Category

Pharmacologic class: Dopamine agonist

Therapeutic class: Antihyperprolactinemic

Indications and Dosages

To treat idiopathic or pituitary adenoma-induced hyperprolactinemic disorders

TABLETS

Adults: 0.25 mg twice/wk. Increased by 0.25 mg twice/wk at 4-wk intervals, if needed, up to 1 mg twice/wk.

Mechanism of Action

Binds with dopamine D2 receptors to block prolactin synthesis and secretion by the anterior pituitary gland, thereby reducing the serum prolactin level.

Contraindications

History of cardiac valvular, pericardial, pulmonary, or retroperitoneal fibrotic disorders; hypersensitivity to cabergoline, ergot derivatives, or their components; uncontrolled hypertension.

Interactions

DRUGS

antihypertensives: Increased risk of hypotension

dopamine antagonists (butyrophenones, metoclopramide, phenothiazines, or thioxanthenes): Decreased cabergoline effectiveness

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Adverse Reactions

CNS: Aggression, asthenia, compulsive/impulse control behaviors (hypersexuality, increased libido, pathological gambling), depression, fatigue, headache, nervousness, paresthesia, somnolence, psychotic disorder, vertigo

CV: Orthostatic hypotension, valvulopathy

EENT: Dry mouth

ENDO: Breast pain

GI: Abdominal pain, constipation, diarrhea, flatulence, indigestion, nausea, vomiting

GU: Dysmenorrhea, increased libido

RESP: Pulmonary effusion, pulmonary fibrosis

SKIN: Alopecia

Other: Extracardiac fibrotic reactions

Childbearing Considerations

PREGNANCY

• It is not known if drug can cause fetal harm.
• Use with caution only if benefit to mother outweighs potential risk to fetus.

LACTATION

• It is not known if drug is present in breast milk.
• Drug is not recommended for women who are or wish to breastfeed because drug action may interfere with lactation.
• A decision should be made to discontinue breastfeeding or the drug.

Nursing Considerations

• Ensure that patient has undergone a cardiovascular evaluation, including an echocardiogram to determine the presence of valvular disease prior to administering cabergoline because the presence of valvular disease is a contraindication to the use of cabergoline therapy.
• Obtain a chest x-ray, an erythrocyte sedimentation rate, and serum creatinine measurement, as ordered, prior to initiating cabergoline therapy and repeat during therapy if the patient develops any signs and symptoms of an extracardiac fibrotic reaction.
• Check serum prolactin level to assess cabergoline’s effectiveness before each dose increase.
• Know that if patient has moderate to severe hepatic impairment, monitor closely for adverse reactions because of decreased cabergoline metabolism.
• Expect patient who takes cabergoline long term to undergo periodic reassessment of cardiac status, including echocardiography, because valvulopathy can occur with prolonged cabergoline use.
• Monitor erythrocyte sedimentation rate, as it may increase in a patient with pleural effusion or pleural fibrosis.

WARNING: Monitor patient for evidence of overdose, such as hallucinations, lightheadedness, nasal congestion, syncope, and tachycardia. If present, prescribe and treat as ordered.

PATIENT TEACHING

1. Urge patient to read and follow printed information that explains how to use cabergoline for best therapeutic results.
2. Advise patient to take drug with meals to help decrease GI distress.
3. Tell patient to take a missed dose as soon as possible within 1 to 2 days. If missed dose isn’t remembered until it’s time for the next dose, instruct him to double the dose if drug is generally well tolerated and doesn’t cause nausea. If drug isn’t well tolerated, instruct patient to consult prescriber before taking the missed dose.
4. Urge patient to change positions slowly to avoid orthostatic hypotension. Tell him to notify prescriber if it occurs.
5. Urge patient to keep regular appointments to monitor drug effectiveness.
6. Advise patient that drug therapy will end when serum prolactin level is normal for 6 months. Explain that he’ll need periodic monitoring to determine whether therapy should resume.
7. Tell female patient of childbearing age to notify prescriber if she is, could be, or plans to become pregnant during therapy; drug may need to be discontinued.
8. Inform patient that cabergoine may cause compulsive or impulse control behaviors such as hypersexuality, incrased libido, and pathological gambling. If present, patient should contact prescriber because a dosage reduction or discontinuation of the drug may be needed. Caution patient to avoid gambling during therapy.

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