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. Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London. Cardiac failure: cases of valvular and pericardial fibrosis have often manifested as cardiac failure. Therefore, valvular fibrosis (and constrictive pericarditis) should be excluded if such symptoms occur. blood problems including low blood count (symptoms may include tiredness), abnormal liver function tests

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. All patients must undergo a cardiovascular evaluation, including echocardiogram to assess the potential presence of asymptomatic valvular disease. Also perform baseline investigations of erythrocyte sedimentation rate or other inflammatory markers, lung function/chest X-ray, serum creatinine and renal function prior to initiation of therapy. If fibrotic valvular disease is detected, the patient should not be treated with cabergoline. The weekly dose may be given as a single administration or divided into two or more doses per week according to patient tolerability. Division of the weekly dose into multiple administrations is advised when doses higher than 1 mg per week are to be given since the tolerability of doses greater than 1 mg taken as a single weekly dose has been evaluated only in a few patients. Cabergoline is prescribed for a number of different medical conditions. Your doctor will tell you why it has been prescribed for you. Advise women of child-bearing age to use non-hormonal methods of contraception during treatment and for one month thereafter.Cabergoline has been associated with somnolence and episodes of sudden sleep onset in patients with Parkinson's disease. Sudden onset of sleep during activities, in some cases without awareness or warning signs, has been reported. Patients must be informed of this and advised to exercise caution while driving or operating machines during treatment with cabergoline. Patients who have experienced somnolence and/or an episode of sudden sleep onset must refrain from driving or operating machines. A reduction of dosage or termination of therapy may be considered (see section 4.7). Cabergoline suppresses lactation through its inhibition of prolactin release from the anterior pituitary gland. Therefore, it is not recommended for any woman wishing to breastfeed. Pathological gambling, increased libido, hypersexuality, compulsive spending or buying, binge eating and compulsive eating can occur in patients treated with dopamine agonists including Cabaser (see section 4.4). The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon. 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. Common side-effects of cabergoline

Before administration of cabergoline, pregnancy should be excluded. Because clinical experience is still limited and the product has a long half-life, as a precautionary measure it is recommended that once regular ovulatory cycles have been achieved women seeking pregnancy discontinue cabergoline one month before intended conception. Should pregnancy occur during treatment, cabergoline is to be discontinued. 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.

Your endocrinologist will measure the levels of prolactin in blood tests. They may also repeat your pituitary MRI scan once you have been treated for a while. To reduce the risk of developing the rare side-effects of cabergoline treatment, your endocrinologist will usually recommend the lowest effective dose. Some patients go into remission after a couple of years of treatment and the cabergoline can be stopped: blood tests and scans will enable your specialist to monitor for any recurrence. What about pregnancy? All patients must undergo a cardiovascular evaluation, including echocardiogram, to assess the potential presence of asymptomatic valvular disease. It is also appropriate to perform baseline investigations of erythrocyte sedimentation rate or other inflammatory markers, lung function/chest x-ray and renal function prior to initiation of therapy. 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?