Cabergoline

This is a long-acting D2 dopamine receptor agonist which may be used for the treatment of hyperprolactinaemia.

The long half-life of cabergoline means that it need only be taken once or twice a week in contrast to the twice daily dosage for bromocriptine.

There are fewer unwanted effects, such as nausea and vomiting, in patients taking cabergoline as compared to patients taking bromocriptine.

Treatment with cabergoline has been associated with the onset of fibrotic cardiac vulvopathy:

• trials suggest that using ergot-derived dopamine agonists such as cabergoline in the treatment of Parkinson's disease is associated with an increased risk of valvular heart disease (1)
  • population studies of patients with Parkinson's disease compared with non-parkinsonian controls have reported that pergolide and cabergoline have a similar risk of inducing fibrotic changes in cardiac valve leaflets. The fibrotic changes cause thickening, retraction, and stiffening of valves, which result in incomplete leaflet coaptation and clinically significant regurgitation, and have necessitated surgical valve replacement in some patients
• however cabergoline at doses sufficient to suppress hyperprolactinaemia for a period of 3-4 years were not associated with an increased risk of clinically significant valvular regurgitation (2)

Reference:

• 1. Antonini A, Poewe W. Fibrotic heart-valve reactions to dopamine-agonist treatment in Parkinson's disease. Lancet Neurol. 2007 Sep;6(9):826-9
• 2. Wakil A et al. Low dose cabergoline for hyperprolactinaemia is not associated with clinically significant valvular heart disease. Eur J Endocrinol. 2008 Oct;159(4):R11-4