In controlled clinical trials, cabergoline given as a single 1 mg administration during the first day post-partum, was effective in inhibiting milk secretion, as well as breast engorgement and pain in 70 - 90% of the women. Less than 5% of women experienced rebound breast symptomatology during the third post-partum week (which was usually mild in severity). As cabergoline suppresses milk production, you should not take it whilst breast feeding. It is often helpful to see whether your periods start again when you have stopped breast feeding, and reassess your prolactin levels, before deciding whether or not to resume cabergoline treatment. Sometimes microprolactinomas resolve after a pregnancy. Rarely, women with large macroprolactinomas will be advised to continue cabergoline treatment and not to breast feed. Your endocrinologist will discuss these decisions with you. Are there any medicines I should avoid when taking cabergoline? Renal insufficiency or ureteral/abdominal vascular obstruction that may occur with pain in the loin/flank and lower limb oedema as well as any possible abdominal masses or tenderness that may indicate retroperitoneal fibrosis.

Pathological gambling, increased libido, hypersexuality, compulsive spending or buying, binge eating and compulsive eating can occur in patients treated with dopamine agonists including Cabaser (see section 4.4). Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London. There were maternotoxic effects but no teratogenic effects in mice given cabergoline at doses up to 8 mg/kg/day (approximately 55 times the maximum recommended human dose) during the period of organogenesis.

Patients with Hepatic Impairment

The starting dose of cabergoline should be 1 mg once daily. In view of its long half-life, increases in daily dose of 500 micrograms to 1mg should be made at weekly intervals (initially) or bi-weekly intervals until the optimal dose is reached.

The pharmacokinetic and metabolic profiles of cabergoline have been studied in healthy volunteers of both sexes and in female hyperprolactinaemic patients. The dose is determined by your doctor who adjusts it individually for you. The recommended dose at the start of treatment is 0.5 –1 mg cabergoline daily. The dose is then increased gradually as directed by the doctor up to a suitable maintenance dose.If you are a woman, you may want to discuss what forms of contraception are suitable for you. Hormonal forms of contraception (such as 'the pill') may not be suitable while you are taking cabergoline. You should avoid becoming pregnant during treatment with cabergoline and for one month after stopping.

After parturition, when the mother elects not to breast feed the infant or when breast feeding is contraindicated due to medical reasons related to the mother or the new-born. Advise patients that side effects including excessive daytime sleepiness or sudden onset of sleep and hypotensive reactions may occur and that they should exercise caution when driving or operating machinery. They should be informed to refrain from driving or operating machinery until the effects have stopped recurring. Before administration of cabergoline, pregnancy should be excluded. Because clinical experience is still limited and the product has a long half-life, as a precautionary measure it is recommended that once regular ovulatory cycles have been achieved women seeking pregnancy discontinue cabergoline one month before intended conception. Should pregnancy occur during treatment, cabergoline is to be discontinued. As a precautionary measure, women who become pregnant should be monitored to detect signs of pituitary enlargement since expansion of pre-existing pituitary tumours may occur during gestation. The recommended therapeutic dosage is 2 mg to 3 mg/day for patients with signs and symptoms of Parkinson's disease. Cabergoline should be given as a single daily dose. Cabergoline generally exerts a hypotensive effect in patients on long-term treatment; Postural hypotension, hot flushes**

Medicines Tools

Treatment with medicines like cabergoline can sometimes cause problems with impulsive types of behaviour. If you notice any changes in your behaviour, such as an increased desire to gamble, binge eat, or spend excessively, or an increased sex drive, you must let your doctor know as soon as possible. Cabergoline suppresses lactation through its inhibition of prolactin release from the anterior pituitary gland. Therefore, it is not recommended for any woman wishing to breastfeed. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine. Read the directions from your doctor carefully and take cabergoline exactly as you are told to. If you are taking cabergoline for the first time, your doctor may give you a small dose and then gradually increase your dose. Slowly increasing your dose like this will help to reduce side-effects, such as dizziness, which can occur during the first few days of treatment. Cabergoline should only be used during pregnancy if clearly indicated and after an accurate benefit/risk evaluation.

Cabergoline generally exerts a hypotensive effect in patients on long-term treatment; Postural hypotension Since cabergoline exerts its therapeutic effect by direct stimulation of dopamine receptors, it should not be concurrently administered with drugs which have dopamine antagonist activity (such as phenothiazines, butyrophenones, thioxanthenes, metoclopramide) since these might reduce the therapeutic effect of cabergoline. All patients must undergo a cardiovascular evaluation, including echocardiogram to assess the potential presence of asymptomatic valvular disease. Also perform baseline investigations of erythrocyte sedimentation rate or other inflammatory markers, lung function/chest X-ray, serum creatinine and renal function prior to initiation of therapy. If fibrotic valvular disease is detected, the patient should not be treated with cabergoline. Regular gynaecological assessment, including cervical and endometrial cytology, is recommended for patients taking cabergoline for extensive periods.Cabergoline crosses the placenta in rats, although it is unknown whether this is also true for humans. Animal studies have shown no embryo or foetal toxicity (Briggs, 2011) Cabergoline has been associated with somnolence and episodes of sudden sleep onset in patients with Parkinson's disease. Sudden onset of sleep during activities, in some cases without awareness or warning signs, has been reported. Patients must be informed of this and advised to exercise caution while driving or operating machines during treatment with cabergoline. Patients who have experienced somnolence and/or an episode of sudden sleep onset must refrain from driving or operating machines. A reduction of dosage or termination of therapy may be considered (see section 4.7). Cabergoline is indicated for second-line therapy in patients who are intolerant or fail treatment with a non-ergot compound, as monotherapy, or as an adjunctive treatment to levodopa and a dopa-decarboxylase inhibitor in the management of Parkinson's disease. Dosage