Cabergoline: a new drug for the treatment of hyperprolactinaemia

Recent clinical studies performed with the novel long acting dopamine agonist cabergoline in the inhibition and suppression of puerperal lactation and in the treatment of hyperprolactinaemic disorders are reviewed. Inhibition of puerperal lactation is achieved with a single 1.0 mg oral administration of the drug, with better efficacy and tolerability results in comparison with bromocriptine, 2.5 mg twice daily for 14 days; 1.0 mg cabergoline (given as 0.25 mg twice daily for 2 days to minimize adverse events) is also effective and well tolerated for the suppression of established lactation. In the treatment of hyperprolactinaemic amenorrhoea, 1-2 mg weekly doses of cabergoline (given on a twice weekly schedule) compare favourably with 5-10 mg daily bromocriptine (given on a twice daily schedule) both for biochemical (normalization of serum prolactin concentrations) and clinical efficacy (resumption of ovulatory cycles) as well as for tolerability. The results of these double-blind, reference therapy-controlled studies have been confirmed by several open studies, that also showed tumour shrinkage in most patients with macroprolactinomas and many patients with microprolactinomas. Persistence of normal or at least lower than pretreatment serum prolactin concentrations for several months after cabergoline withdrawal, together with persistence of cyclic ovulatory menses, has been also demonstrated. It is therefore suggested that cabergoline should become the drug of choice when inhibition or suppression of puerperal lactation is required and for the treatment of hyperprolactinaemic disorders.