Cabergolina

Cabergolina is an ergot-derived dopamine D2 receptor agonist used primarily in the management of hyperprolactinemia and prolactin-secreting pituitary tumors (prolactinomas). It lowers prolactin levels by stimulating dopamine receptors on lactotroph cells in the pituitary, which can also lead to a reduction in tumor size. In addition to treating hyperprolactinemia, cabergolina is used in some cases of infertility related to elevated prolactin and, in certain regions, as an adjunct treatment for Parkinson's disease.

Administration and dosing are by mouth in tablet form. For hyperprolactinemia, a common starting regimen is 0.25 mg twice weekly, with gradual increases every few weeks based on response and tolerability. Maintenance doses typically range from 0.5 to 2 mg per week, divided into one or two doses, though some patients may require higher weekly doses up to around 4.5 mg in certain cases. The drug has a long half-life, allowing less frequent dosing, but doses should be individualized and adjusted under medical supervision. Prolactin levels and pituitary tumor size by imaging are used to monitor effectiveness.

Safety and monitoring considerations include the risk of valvular heart disease with long-term or high-dose use, so clinicians may perform baseline and periodic echocardiography in some patients. Common adverse effects include nausea, dizziness, fatigue, headaches, and orthostatic hypotension; less frequent but important concerns are impulse control disorders and fibrotic reactions in rare cases. Cabergolina is contraindicated in people with hypersensitivity to the drug or to ergot derivatives and in those with known active valvular heart disease. Pregnancy should be discussed with a clinician, as risks and benefits need careful assessment.