Cabergoline

Cabergoline is a prescription tablet that acts like dopamine to lower prolactin levels. It is approved for high prolactin levels, including prolactin-secreting pituitary tumours. In the UK it is also approved for stopping breast milk production, and in the UK and EU as a second-line treatment for Parkinson's disease.

What it is

Cabergoline is a tablet medicine from the group called dopamine agonists. It is derived from ergot, a family of compounds that also includes bromocriptine and pergolide ^[4]. It is sold as Dostinex for prolactin disorders and, in the UK, as Cabaser for Parkinson's disease ^{[1, 2, 3]}. It is a prescription-only medicine and should only be used under medical supervision.

How it works

Cabergoline binds strongly to dopamine D2 receptors. In the pituitary gland, dopamine is the main signal that holds back prolactin release, so cabergoline directly lowers prolactin secretion ^[1]. It is absorbed quickly, with peak blood levels 2 to 3 hours after a dose, and it has a long half-life of about 63 to 69 hours in the US label, or 63 to 115 hours in the UK product information ^{[1, 2]}.

Approved medical uses

• Hyperprolactinaemic disorders (high prolactin), whether the cause is unknown or a prolactin-secreting pituitary tumour (prolactinoma). This is the only approved use in the US ^{[1, 2]}.
• Stopping breast milk production after birth, or suppressing established lactation, in the UK ^[2]. The US label says cabergoline should not be used for this purpose ^[1].
• Parkinson's disease in the UK and EU, as a second-line treatment for people who cannot tolerate or do not respond to non-ergot medicines ^{[3, 4]}.

What the research shows

• Prolactinomas. The Endocrine Society guideline recommends cabergoline over other dopamine agonists, because it is more effective at normalising prolactin and shrinking pituitary tumours ^[5]. A 2023 review describes it as the treatment of choice for prolactinomas, able to control the disease and restore fertility, with lasting cure in about one third of patients ^[6].
• Stopping treatment. The guideline states that, after successful treatment with normal prolactin and no visible tumour on MRI, treatment may be tapered and perhaps stopped. Prolactin rises again in roughly 26% to 69% of people, most often in the first year, so long-term follow-up is needed ^[5].
• Heart valves in Parkinson's disease. In 2008, a European review concluded that the risk of heart valve fibrosis is well established for cabergoline and pergolide. It restricted their use in Parkinson's disease to second-line treatment, lowered the maximum dose and required heart scans (echocardiography) before and during treatment ^[4].
• Heart valves at lower doses for high prolactin. The 2011 guideline noted that six of seven studies, covering more than 500 people with prolactinomas, found no clinically significant valve disease at the usual doses ^[5]. A later US study of 174 people treated for high prolactin found that having at least one valve with grade 2 or higher leakage (regurgitation) was more common with cabergoline alone (37%) than with bromocriptine alone (18%), and that greater total exposure to cabergoline was linked to more valve leakage. The authors described the changes as mostly mild and called for research on who needs echocardiographic screening ^[7].

Known risks and side effects

• Heart valve disease (valvulopathy): cabergoline must not be used by people with a history of heart valve disorders. An echocardiogram is needed before long-term treatment and repeated every 6 to 12 months or as advised ^{[1, 2, 3]}.
• Fibrosis: scarring of the lining of the lungs, heart (pericardium) or the back of the abdomen (retroperitoneum) can occur with long-term use of ergot derivatives. Warning symptoms include breathlessness, chest pain, cough and abdominal symptoms ^{[1, 3]}.
• Low blood pressure on standing (orthostatic hypotension), and it should not be used with uncontrolled high blood pressure ^[1].
• Impulse control disorders, such as pathological gambling, hypersexuality, compulsive spending and binge eating ^{[1, 2, 3]}.
• Sudden sleep onset and sleepiness. People affected should not drive ^[3].
• After childbirth: serious events including high blood pressure, heart attack, seizures and psychiatric disorders have been reported in women given cabergoline after giving birth ^[2].
• Common effects include nausea (27% versus 20% on placebo), headache (26% versus 25% on placebo) and dizziness (15% versus 5% on placebo) ^[1].

Blood tests commonly monitored

• Prolactin: the main measure of response, with regular checks after stopping treatment because high prolactin can return ^[5].
• Erythrocyte sedimentation rate (ESR): a marker of inflammation, checked to look for fibrosis ^{[1, 3]}.
• Serum creatinine: checked as part of fibrosis monitoring ^{[1, 3]}.
• Other checks (not blood tests): echocardiography before and during treatment, chest X-ray where fibrosis is suspected, and blood pressure ^{[1, 3]}.

Sources

1. US Food and Drug Administration. Dostinex (cabergoline) tablets prescribing information. FDA, 2025. accessdata.fda.gov
2. Pfizer Limited. Dostinex Tablets: Summary of Product Characteristics. Electronic Medicines Compendium, 2024. medicines.org.uk
3. Pfizer Limited. Cabaser Tablets: Summary of Product Characteristics. Electronic Medicines Compendium, 2018. medicines.org.uk
4. European Medicines Agency. Ergot-derived dopamine agonists: referral. EMA, 2008. ema.europa.eu
5. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JAH. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 2011. academic.oup.com
6. Auriemma RS, Pirchio R, Pivonello C, Garifalos F, Colao A, Pivonello R. Approach to the patient with prolactinoma. Journal of Clinical Endocrinology & Metabolism, 2023. academic.oup.com
7. Budayr A, Tan TC, Lo JC, Zaroff JG, Tabada GH, Yang J, Go AS. Cardiac valvular abnormalities associated with use and cumulative exposure of cabergoline for hyperprolactinemia: the CATCH study. BMC Endocrine Disorders, 2020. link.springer.com

Related

Last reviewed 7 October 2026. General information, not medical advice. Found a mistake? Email [email protected].