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Cabergoline is a tablet treatment used to reduce the production of a hormone called prolactin by the pituitary gland (a gland at the base of the brain). If you have a prolactinoma (overproduction of prolactin by a cluster of cells in the pituitary), cabergoline treatment is also used to shrink the size of the swelling on the pituitary gland.
Cabergoline is a long-acting medicine, which only needs to be taken once or twice a week. Your specialist will recommend the appropriate dose for you.
Side-effects are reduced if you take the cabergoline with food.
Cabergoline may make you feel a bit dizzy, especially when you stand up suddenly. It may also cause nausea or headaches. These side-effects are reduced by taking the cabergoline with food. Your specialist will also usually recommend starting with a low dose of cabergoline and gradually increasing the dose if necessary, to reduce the risk of developing these side effects. These side-effects usually settle down as your body gets used to the medicine.
In patients taking cabergoline to treat Parkinson’s disease (an unrelated disease of the nervous system in older people), at doses at least ten times those used to treat prolactinomas, cases of heart valve damage have been reported. Very rare cases of heart valve damage have been reported in patients taking low-dose cabergoline to treat prolactinomas. Your doctor will usually listen to your heart before starting cabergoline treatment. They may arrange an echocardiogram heart scan if you need long-term treatment with cabergoline. If you are concerned that you are becoming more short of breath or developing ankle swelling, you should alert your GP or your endocrinologist (hospital hormone specialist).
Very rarely, cabergoline can cause severe psychiatric disturbances or abnormal behaviour, for example a strong desire to gamble or an increased sex drive. These problems usually settle when the treatment is stopped. If you are concerned that you may be affected in this way, you should consult your GP or your endocrinologist.
Your endocrinologist will measure the levels of prolactin in blood tests. They may also repeat your pituitary scan once you have been treated for a while. To reduce the risk of developing the rare sideeffects of cabergoline treatment, your endocrinologist will usually recommend the lowest effective dose. Some patients go into remission after a few years of treatment: the blood tests and scans will enable your specialist to re-assess the need for you to continue taking the cabergoline as your treatment progresses.
Once women start taking cabergoline, their fertility is often restored. This may happen quickly, even before menstrual periods start again. If you do not want to become pregnant, you should use non-hormonal contraception (e.g. barrier contraception) as soon as you start taking cabergoline treatment.
You should discuss your contraceptive options with your endocrinologist. You should discuss with your endocrinologist what they recommend if you find you are pregnant whilst taking cabergoline treatment. Most women are advised to stop taking the cabergoline when they confirm a pregnancy (have a positive pregnancy test). Although there is no evidence that cabergoline treatment in pregnancy causes problems, it is preferable to avoid any medicine in pregnancy unless it is essential. Some women with large prolactinomas may be advised to continue cabergoline treatment in pregnancy: your endocrinologist will discuss this decision with you if this is the case.
Cabergoline treatment suppresses breast milk production, so you should not take it whilst breast feeding. Your doctor will advise you if and when you should resume cabergoline treatment when you have stopped breast feeding: it is often helpful to see whether your periods start again and to reassess your prolactin levels before making this decision. Sometimes small prolactinomas resolve after a pregnancy. Rarely, women with large prolactinomas will be advised to continue cabergoline treatment and not to breast feed: your endocrinologist will discuss this decision with you if this is the case.
You should not take cabergoline with erythromycin or clarithromycin (these are types of antibiotics), as they increase the cabergoline level in the blood, increasing the risk of side-effects. You should also avoid domperidone and metoclopramide (sometimes used to treat nausea or vomiting), as they counter-act the effect of the cabergoline.
Other information: You should read the information leaflet that comes with the cabergoline.
If you have further questions, you should discuss them with your GP, your endocrinologist or the endocrine specialist nurse.
Royal Sussex County Hospital: 01273 696955 Endocrine specialist nurse extension 4379
Princess Royal Hospital, Haywards Heath: 01444 441881 Endocrine specialist nurse extension 5660.
If you have any urgent or emergency questions then your GP can advise you or they will contact the hospital on your behalf.
Patient self-help group and further information: The Pituitary Foundation is a pituitary patient support group. They have a patient information leaflet about prolactinomas which you can download from their website.
This information is intended for patients receiving care in Brighton & Hove or Haywards Heath.
The information in this leaflet is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.
Publication Date: September 2019
Review Date: June 2021