Cabgolin (cabergoline) is a dopamine promoter used to treat patients who have elevated levels of the hormone prolactin.

Prolactin is produced by the pituitary gland, though excess production is often caused by a non-cancerous tumor called a prolactinoma. When caused by a prolactinoma, treatment with Cabgolin will also help shrink the tumor, often completely resolving the issue without need for surgery.

Cabgolin may also be used when prolactin levels are elevated for unknown reasons.

Excess prolactin levels are most common in women under age 50, but both genders of any age can develop the condition. Cabgolin can be used in both genders and any age, though very young and elderly patients may require increased monitoring.

Symptoms of High Prolactin

High levels of prolactin interfere with the production of estrogen in the ovaries of women or the production of testosterone in the testes of men. The most noticeable symptoms are those of low estrogen or testosterone, though post-menopausal women may not notice many symptoms.

Symptoms in women:

• Unexplained breast milk production
• Missed or erratic periods
• Difficulty becoming pregnant
• Hot flashes

Symptoms in men:

• Enlarged breasts
• Loss of libido
• Impotence
• Fatigue
• Loss of muscle mass

Large prolactinomas, called macroadenomas, may cause additional symptoms in both sexes due to pressure on surrounding tissues:

• Vision changes
• Underactive thyroid function
• Underactive Adrenal glands
• Headaches

Note that all of the above symptoms are much more commonly caused by other ailments. It is very important that a doctor diagnose elevated prolactin levels prior to starting treatment with Cabgolin.

Treatment with Cabgolin

Cabgolin is one of the more effective treatments available for reducing high levels of prolactin, particularly when caused by a prolactinoma. The medication also tends to produce fewer side effects than alternate medications used to treat the same condition.

Cabgolin treatment should start with smaller doses, gradually increased over time if needed:

• Take 0.25 mg twice per week for 4 weeks.
• If improvements are not seen after 4 weeks, take 0.50 mg twice per week for 4 weeks.
• Continue increasing each dose by 0.25 mg every 4 weeks until improvements are noticed or until reaching 1 mg per dose (2 mg per week).
• Do not exceed 2 mg per week without explicit doctor instruction.

Prolactin levels should begin to fall within 2 or 3 weeks of starting an effective dose. As levels fall, symptoms should begin to reverse. Ideally a doctor will check prolactin levels to determine how well Cabgolin is working. It may take several months for a prolactinoma to shrink significantly, even if prolactin levels are reduced in the interim.

Treatment with Cabgolin may continue for months or years after prolactin levels were normalized or prolactinomas were destroyed; after some time treatment may be stopped to see if the body can regulate the hormone on its own. If levels rise again or prolactinomas return, treatment may continue indefinitely.

Precautions & Side Effects

Patients with certain preexisting conditions should use extra caution if taking Cabgolin, and do so only with doctor approval:

• High blood pressure
• Liver or heart valve disease
• Pulmonary, pericardial, or retroperitoneal fibrosis

Gastrointestinal side effects are relatively common when starting treatment and when doses are increased; symptoms should fade as the body adjusts to treatment. If nausea, vomiting, stomach cramps, or constipation are persistent or severe, a doctor or pharmacist may be able to suggest solutions for managing individual side effects.

More serious side effects, though very rare, should be brought to the attention of a doctor before continuing treatment:

• Difficulty breathing
• Persistent coughing
• Severe fatigue
• Mood swings
• Breast pain
• Edema

This medication is derived from ergot; individuals with ergot sensitivity should not buy Cabgolin.