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Cabergoline for men & women: Dostinex (Know Your Medicine)

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Also very rarely, cabergoline can cause psychiatric disturbances or abnormally impulsive behaviour, for example a strong desire to gamble or a greatly increased sex drive. It is worth letting your ‘nearest and dearest’ know about this, just in case they notice any changes of this sort. If you are concerned you should consult your GP or your endocrinologist. These problems usually settle when the treatment is stopped. How is the response to cabergoline treatment monitored? Binge eating (eating large amounts of food in a short time period) or compulsive eating (eating more food than normal and more than is needed to satisfy your hunger) As expected for dopamine agonists, dose response for both efficacy and side effects appears to be linked to individual sensitivity. Optimization of dose should be obtained through slow initial dose titration, from starting doses of 1 mg daily. The dosage of concurrent levodopa may be gradually decreased, while the dosage of cabergoline is increased, until the optimum balance is determined. In view of the long half-life of the compound, increments of the daily dose of 0.5-1 mg should be done at weekly (initial weeks) or bi-weekly intervals, up to optimal doses. No information is available about interaction between cabergoline and other ergot alkaloids: therefore the concomitant use of these medications during long term treatment with cabergoline is not recommended. 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.

serious chest complaint (e.g. pain in the chest when breathing, fluid in the lungs, inflammation or infection of the lungs).Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, 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. If pregnancy is confirmed during therapy, then cabergoline should be discontinued to minimise foetal exposure. However, Briggs (2011) states that there is no evidence that exposure to cabergoline during pregnancy is harmful. Schaefer (2007) concludes that continuing treatment is not grounds for termination or invasive diagnostic procedure. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

blood problems including low blood count (symptoms may include tiredness), abnormal liver function tests Cabergoline generally exerts a hypotensive effect in patients on long-term treatment; Postural hypotension, hot flushes**

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. It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

There are other medicines such as other ergot alkaloids, medicines to prevent vomiting (metoclopramide), and macrolide antibiotics (such as erythromycin) that may affect the activity and tolerability of Cabergoline. Each amber glass bottle contains 20 tablets and a silica gel desiccant sealed with an aluminium membrane and a child-resistant screw cap. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia. Because pregnancy might occur prior to reinitiation of menses, a pregnancy test is recommended at least every four weeks during the amenorrhoeic period and, once menses are reinitiated, every time a menstrual period is delayed by more than three days. Women who wish to avoid pregnancy should be advised to use mechanical contraception during treatment with cabergoline and after discontinuation of cabergoline until recurrence of anovulation. 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. Due to the long half-life of the drug and limited data on in utero exposure, women planning to become pregnant should discontinue cabergoline one month before intended conception. If conception occurs during therapy, treatment should be discontinued as soon as pregnancy is confirmed to limit foetal exposure to the drug.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 After oral administration of the labelled compound, radioactivity was rapidly absorbed from the gastrointestinal tract as the peak of radioactivity in plasma was between 0.5 and 4 hours. Valvulopathy has been associated with cumulative doses, therefore patients should be treated with the lowest effective dose. At each visit, the risk benefit profile of cabergoline treatment for the patient should be reassessed to determine the suitability of continued treatment with cabergoline. 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 sideeffects. You should also avoid domperidone and metoclopramide (sometimes used to treat nausea or vomiting), as they counter-act the effect of the cabergoline. Are there alternatives to cabergoline treatment? There are no adequate and well-controlled studies from the use of cabergoline in pregnant women. Animal studies have not demonstrated teratogenic effects, but reduced fertility and embryo-toxicity were observed in association with pharmacodynamic activity (see section 5.3).

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