PDR MEMBER LOGIN:
  • PDR Search

    Required field
  • Advertisement
  • CLASSES

    Anti-Parkinson Agents, Dopamine Agonists
    Prolactin Inhibitors

    DEA CLASS

    Rx

    DESCRIPTION

    Ergoline-derived dopamine agonist
    Used for hyperprolactinemia; effective for restless legs syndrome, but not a first-line treatment option
    Evaluate cardiac status prior to treatment initiation; conduct clinical and diagnostic monitoring periodically in all patients to evaluate the risk of cardiac valvulopathy

    COMMON BRAND NAMES

    Dostinex

    HOW SUPPLIED

    Cabergoline/Dostinex Oral Tab: 0.5mg

    DOSAGE & INDICATIONS

    For the treatment of hyperprolactinemia, either idiopathic or due to a pituitary adenoma.
    Oral dosage
    Adults

    Initially, 0.25 mg PO twice per week. Perform a cardiovascular evaluation and consider echocardiography to assess for valvular disease before initiating treatment. May titrate by 0.25 mg/dose no more than every 4 weeks up to 1 mg PO twice per week, if needed. If the patient does not respond adequately and no additional benefit is observed with higher doses, use the lowest dose that achieved maximal response and consider other therapeutic approaches. Once weekly administration has also been found effective at dosages of 0.5 to 3 mg/week PO. Prolactin levels normalized in 73% of patients, and tumor size decreased by a mean of 31% (range: 5% to 95%). CONTINUED TREATMENT: Efficacy beyond 24 months of treatment has not been established. Periodic assessment of cardiac status and consideration of echocardiography are needed for patients who receive long-term treatment. Discontinuation may be considered after 6 months of acceptable serum prolactin concentrations. Assess the need for re-initiation of cabergoline treatment by periodic prolactin determinations.

    Vaginal dosage†
    Adult females

    Safety and efficacy have not been established. Case reports indicate that 0.5 mg PV 2 to 5 times per week may be effective in normalizing prolactin levels for those intolerant to oral treatment. Use the lowest effective dose.

    For the treatment of restless legs syndrome (RLS)†.
    Oral dosage
    Adults

    Safety has not been established, but studies have shown efficacy. Initially, 0.5 mg PO once daily as a single evening dose. Slowly titrate until symptoms resolve or intolerance limits further adjustment. Mean effective dosage from trials: 2 mg/day PO once daily as a single evening dose (range: 1 to 4 mg/day PO). According to the American Academy of Neurology guideline, there is strong evidence to support efficacy for the use of cabergoline for moderate to severe restless legs syndrome in adults; however, cabergoline is rarely used in clinical practice because of the risk of cardiac valvulopathy. The American Academy of Sleep Medicine guidelines state that cabergoline should only be used if other approved treatments (e.g., pramipexole, ropinirole) have been tried first and are ineffective. A cardiac evaluation and consideration of echocardiography to assess for valvular disease are recommended before initiating treatment with cabergoline; periodic re-evaluation should occur in patients who receive long-term treatment.

    †Indicates off-label use

    MAXIMUM DOSAGE

    Adults

    The usual maximum for hyperprolactinemia is 1 mg PO twice per week.

    Geriatric

    The usual maximum for hyperprolactinemia is 1 mg PO twice per week.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    Infants

    Safety and efficacy have not been established.

    DOSING CONSIDERATIONS

    Hepatic Impairment

    Although specific guidelines are not available, caution and careful monitoring should be used when administering cabergoline to patients with hepatic disease, particularly if significant hepatic impairment is present.

    Renal Impairment

    No dosage adjustments are needed.

    ADMINISTRATION

    Oral Administration

    May be administered without regard to meals.

    STORAGE

    Dostinex:
    - Store at controlled room temperature (between 68 and 77 degrees F)

    CONTRAINDICATIONS / PRECAUTIONS

    Ergot alkaloid hypersensitivity

    Cabergoline is contraindicated in patients with a known ergot derivative or ergot alkaloid hypersensitivity because of the possibility of an allergic reaction.

    Valvular heart disease

    Cabergoline is contraindicated in patients with a history of valvular heart disease, as suggested by anatomical evidence of valvulopathy of any valve, determined by pre-treatment evaluation including echocardiographic demonstration of valve leaflet thickening, valve restriction, or mixed valve restriction stenosis. Postmarketing cases of cardiac valvulopathy have been reported in patients receiving cabergoline. These cases have generally occurred during the use of high doses of the drug (i.e., more than 2mg/day). Cases of cardiac valvulopathy have also been reported in patients receiving lower doses of cabergoline for the treatment of hyperprolactinemic disorders. Cautious use of cabergoline is recommended in patients who have been exposed to other medications associated with valvulopathy. All patients should undergo a cardiovascular evaluation, including an echocardiogram, before cabergoline initiation to assess for valvular disease. If valvular disease is present, cabergoline treatment should not be initiated. Clinical and diagnostic monitoring (e.g., chest x-ray, CT scan, cardiac echocardiogram) should be conducted periodically in all patients receiving cabergoline to evaluate the risk of cardiac valvulopathy. Echocardiographic monitoring should be conducted every 6 to 12 months or as needed by the presence of edema, new cardiac murmur, dyspnea, congestive heart failure, or other signs and symptoms of valvulopathy. Cabergoline should be discontinued if an echocardiogram demonstrates new valvular regurgitation, valvular restriction, or valve leaflet thickening.

    Constrictive pericarditis, pulmonary fibrosis, retroperitoneal fibrosis

    Cabergoline is contraindicated for use by patients with a history of pulmonary, pericardial, cardiac valvular or retroperitoneal fibrotic disorders. Cabergoline should not be used in patients with a history of or current signs/clinical symptoms of respiratory, cardiac, or other disorders linked to fibrotic tissue such as pulmonary fibrosis, retroperitoneal fibrosis, or constrictive pericarditis. One case of constrictive pericarditis with subsequent pleuropulmonary inflammatory-fibrotic syndrome has occurred with cabergoline administration. Similar to other ergot derivatives, cabergoline can cause fibrotic changes, inflammatory fibrosis, pleural effusion, and valvulopathy. Therefore, patients receiving cabergoline should be monitored for the potential development of fibrotic disorders. Clinical and diagnostic monitoring (e.g., erythrocyte sedimentation rate, chest x-ray, serum creatinine) should be considered at baseline and as needed during treatment. Potential signs and symptoms of fibrotic disorders, including dyspnea, chronic cough, chest pain, renal insufficiency, ureteral/abdominal vascular obstruction, abdominal masses or tenderness, and cardiac failure, should be promptly evaluated. Discontinuation of cabergoline may result in improvement in the symptoms of pleural effusion and pulmonary fibrosis.

    Hypertension

    Like other ergot derivatives, cabergoline is contraindicated in patients with uncontrolled hypertension. Ergot-derived dopamine agonists have been associated with hypertension, strokes, and seizures. Patients should be advised to immediately report new or worsening hypertension, severe headaches, or other adverse CNS effects.

    Hypotension, orthostatic hypotension

    Cabergoline has been associated with orthostatic hypotension. Initiating treatment with dosages greater than 1 mg are most likely to produce this effect. Cabergoline should be used cautiously in those with a history of hypotension or those receiving medications known to cause hypotension.

    Hepatic disease

    Since cabergoline is extensively metabolized by the liver, caution should be used, and careful monitoring implemented, when administering cabergoline to patients with hepatic disease. No effects on the kinetics of cabergoline have been observed in patients with mild to moderate hepatic impairment, but patients with significant impairment had significantly increased exposure to the drug.

    Impulse control symptoms

    Some patients receiving dopamine agonists, including cabergoline, have reported impulse control symptoms/compulsive behaviors, including pathological gambling, increased libido, and hypersexuality. Generally, these impulse control symptoms are reversible after the dose is reduced or the drug is discontinued. Practitioners should inquire periodically about new or worsening impulsivity in patients receiving cabergoline. Likewise, patients should be instructed to report such changes while receiving cabergoline. Dose reduction or discontinuation should be considered in those who experience these effects.

    Eclampsia, preeclampsia, pregnancy, pregnancy testing

    Although the available data suggest a low fetal risk in early pregnancy, the risk to the developing fetus during chronic cabergoline exposure is unknown. Therefore, cabergoline should be used during pregnancy only if clearly needed. Dopamine agonists, like cabergoline, should generally not be used in patients with pregnancy-induced hypertension (e.g., preeclampsia, eclampsia, or postpartum hypertension), unless the potential benefit is judged to outweigh the possible risk. There is an association of use of these drugs with hypertension, seizures, myocardial infarction, and stroke in postpartum patients. In one review of over 200 pregnancies in cabergoline-exposed women, no increased miscarriage rates, congenital malformations, abnormal distribution of birthweights, or disturbances in postnatal development were noted in comparison to the expected population rate. The range of embryo-fetal exposure to cabergoline was between 1 and 144 days. Among 56 women receiving cabergoline for amenorrhea secondary to hyperprolactinemia, the following outcomes were reported in 17 subsequent pregnancies: 1 spontaneous abortion, 6 pending outcomes, and 10 term infants with normal physical and mental development. In a separate group of women receiving cabergoline for hyperprolactinemia, the following outcomes were reported in 61 pregnancies: 5 elective abortions (1 suspected malformation), 6 spontaneous abortions, 1 hydatidiform mole, and 49 live births (1 minor defect and 1 trisomy). In one study enrolling 47 hyperprolactinemic females, 9 became pregnant against medical advice. Treatment with cabergoline was interrupted when pregnancy was diagnosed. The pregnancy outcomes included 1 voluntary termination, 1 spontaneous termination, and 7 healthy term infants showing normal development during 8 years of continued follow-up. One case describes a patient with two separate pregnancies and the use of levodopa and cabergoline for Parkinson's disease throughout the pregnancies. There were no fetal complications; however, C-section was required in the second birth due to placental abruption. Instruct patients to notify their physician if they suspect they are pregnant, become pregnant, or intend to become pregnant during therapy. Cabergoline treatment in a patient with infertility due to hyperprolactinemia may restore fertility. Conduct pregnancy testing if there is any suspicion of pregnancy.

    Breast-feeding

    A decision should be made whether to discontinue breast-feeding or to discontinue the drug, taking into account the importance of the drug to the mother. Cabergoline interferes with lactation due to a central prolactin-lowering effect. Cabergoline is also not indicated for postpartum lactation inhibition because the use of other dopamine agonists (e.g., bromocriptine) for this purpose has resulted in hypertension, stroke, and seizures.

    Geriatric

    Clinical studies of cabergoline did not include a sufficient number of patients 65 years and older to determine whether they respond differently than younger adults. Other reported clinical experience has not identified differences in responses between geriatric and younger adult patients. However, cabergoline dosing and titration should be more cautious in geriatric patients, starting at the lower end of the dose range to account for differences in renal, hepatic, or cardiac systems as well as concomitant disease states and medications.

    Children, infants

    The safety and efficacy of cabergoline in pediatric patients, particularly children and infants, have not been established.

    ADVERSE REACTIONS

    Severe

    visual impairment / Early / 1.0-1.0
    peptic ulcer / Delayed / Incidence not known
    retroperitoneal fibrosis / Delayed / Incidence not known
    pericarditis / Delayed / Incidence not known
    pleural effusion / Delayed / Incidence not known
    pulmonary fibrosis / Delayed / Incidence not known
    cardiac valvulopathy / Delayed / Incidence not known
    heart failure / Delayed / Incidence not known

    Moderate

    constipation / Delayed / 7.0-10.0
    orthostatic hypotension / Delayed / 4.0-4.0
    hot flashes / Early / 3.0-3.0
    edema / Delayed / 0-1.0
    peripheral edema / Delayed / 1.0-1.0
    hypotension / Rapid / 0-1.0
    palpitations / Early / 1.0-1.0
    fluid retention / Delayed / Incidence not known
    confusion / Early / Incidence not known
    psychosis / Early / Incidence not known
    hallucinations / Early / Incidence not known
    dyskinesia / Delayed / Incidence not known
    impulse control symptoms / Delayed / Incidence not known

    Mild

    nausea / Early / 27.0-29.0
    headache / Early / 26.0-26.0
    dizziness / Early / 15.0-17.0
    fatigue / Early / 5.0-7.0
    asthenia / Delayed / 6.0-6.0
    abdominal pain / Early / 5.0-5.0
    dyspepsia / Early / 2.0-5.0
    vomiting / Early / 2.0-4.0
    vertigo / Early / 1.0-4.0
    flatulence / Early / 0-2.0
    xerostomia / Early / 0-2.0
    diarrhea / Early / 0-2.0
    paresthesias / Delayed / 0-2.0
    mastalgia / Delayed / 1.0-2.0
    musculoskeletal pain / Early / 0-2.0
    weight gain / Delayed / 0-1.0
    anorexia / Delayed / 0-1.0
    throat irritation / Early / 1.0-1.0
    dental pain / Delayed / 1.0-1.0
    weight loss / Delayed / 0-1.0
    drowsiness / Early / 0-1.0
    insomnia / Early / 0-1.0
    dysmenorrhea / Delayed / 0-1.0
    malaise / Early / 1.0-1.0
    syncope / Early / 0-1.0
    anxiety / Delayed / 0-1.0
    pruritus / Rapid / 0-1.0
    acne vulgaris / Delayed / 0-1.0
    arthralgia / Delayed / 0-1.0
    epistaxis / Delayed / 0-1.0
    rhinitis / Early / 0-1.0
    nasal congestion / Early / 0-1.0
    cough / Delayed / Incidence not known
    libido increase / Delayed / Incidence not known
    alopecia / Delayed / Incidence not known

    DRUG INTERACTIONS

    Acebutolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Aliskiren: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including aliskiren. Cabergoline has been associated with hypotension in some instances. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Aliskiren; Amlodipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including aliskiren. Cabergoline has been associated with hypotension in some instances. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including aliskiren. Cabergoline has been associated with hypotension in some instances. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including aliskiren. Cabergoline has been associated with hypotension in some instances. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Aliskiren; Valsartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including aliskiren. Cabergoline has been associated with hypotension in some instances. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Almotriptan: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.
    Alpha-blockers: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including alpha-blockers. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amiloride: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including potassium-sparing diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amiloride; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including potassium-sparing diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amlodipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amlodipine; Atorvastatin: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amlodipine; Benazepril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amlodipine; Celecoxib: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amlodipine; Olmesartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amlodipine; Valsartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Amyl Nitrite: (Moderate) Cabergoline should be used cautiously with drugs that can lower blood pressure, including systemic nitrates. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Angiotensin II receptor antagonists: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Angiotensin-converting enzyme inhibitors: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Aripiprazole: (Moderate) Cabergoline should not be coadministered with aripiprazole due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of aripiprazole may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as aripiprazole.
    Asenapine: (Moderate) Cabergoline should not be coadministered with asenapine due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of asenapine may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as asenapine.
    Atenolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Atenolol; Chlorthalidone: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Azilsartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Azilsartan; Chlorthalidone: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Belladonna Alkaloids; Ergotamine; Phenobarbital: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Benazepril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Bendroflumethiazide; Nadolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Beta-blockers: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Betaxolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Bisoprolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Brexpiprazole: (Moderate) Cabergoline should not be coadministered with brexpiprazole due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of brexpiprazole may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as brexpiprazole.
    Brimonidine; Timolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Bumetanide: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including loop diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Candesartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Candesartan; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Captopril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Cariprazine: (Moderate) Cabergoline should not be coadministered with cariprazine due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of cariprazine may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as cariprazine.
    Carteolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Carvedilol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Chlorothiazide: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Chlorpromazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Chlorthalidone: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Chlorthalidone; Clonidine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including clonidine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Clomipramine: (Moderate) Cabergoline should not be coadministered with clomipramine, if possible. The prolactin-lowering effect of cabergoline may be diminished by medications that may increase prolactin levels such as clomipramine.
    Clonidine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including clonidine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Clozapine: (Moderate) Cabergoline should not be coadministered with clozapine due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of clozapine may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as clozapine. It should be noted that the effect of clozapine on prolactin is generally not clinically relevant.
    Codeine; Phenylephrine; Promethazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Codeine; Promethazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Deutetrabenazine: (Moderate) Cabergoline should not be coadministered with deutetrabenazine, if possible. The prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as deutetrabenazine.
    Diethylpropion: (Moderate) Cabergoline has been associated with valvulopathy and should be used with caution in patients exposed to other medications associated with valvulopathy. Valvulopathy has been very rarely reported with diethylpropion, but the causal relationship remains uncertain. The potential risk of possible serious adverse effects such as valvular heart disease should be assessed carefully against the potential benefit of the use of these drugs together.
    Dihydroergotamine: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Diltiazem: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including diltiazem. Cabergoline has been associated with hypotension. Initial doses of carbergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Dorzolamide; Timolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Doxazosin: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including alpha-blockers. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Droperidol: (Moderate) Cabergoline should not be coadministered with droperidol due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of droperidol may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the antipsychotic effect of droperidol. In addition, both cabergoline and droperidol may cause hypotension, and additive effects may occur during coadministration. It may be advisable to monitor blood pressure.
    Eletriptan: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.
    Enalapril, Enalaprilat: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Enalapril; Felodipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including felodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Eprosartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Ergoloid Mesylates: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Ergonovine: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Ergot alkaloids: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Ergotamine: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Ergotamine; Caffeine: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Esmolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Ethacrynic Acid: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including loop diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Felodipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including felodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Fluphenazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Fosinopril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Frovatriptan: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.
    Furosemide: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including loop diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Guanfacine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including guanfacine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Haloperidol: (Moderate) Cabergoline should not be coadministered with haloperidol due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of haloperidol may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as haloperidol.
    Hydralazine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including hydralazine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Hydralazine; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including hydralazine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Hydralazine; Isosorbide Dinitrate, ISDN: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including hydralazine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with drugs that can lower blood pressure, including systemic nitrates. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Hydrochlorothiazide, HCTZ; Methyldopa: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including methyldopa. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. In addition, the prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as methyldopa. Monitor for reduced response to cabergoline. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Iloperidone: (Moderate) Cabergoline should not be coadministered with iloperidone due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of iloperidone may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as iloperidone.
    Indapamide: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including indapamide. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Irbesartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Irbesartan; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Isosorbide Dinitrate, ISDN: (Moderate) Cabergoline should be used cautiously with drugs that can lower blood pressure, including systemic nitrates. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Isosorbide Mononitrate: (Moderate) Cabergoline should be used cautiously with drugs that can lower blood pressure, including systemic nitrates. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Isradipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including isradipine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Labetalol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Levamlodipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Levobetaxolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Levobunolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Lisinopril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Loop diuretics: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including loop diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Lorcaserin: (Moderate) The prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as lorcaserin. Lorcaserin moderately elevates prolactin levels.
    Losartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Loxapine: (Moderate) Cabergoline should not be coadministered with loxapine due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of loxapine may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as loxapine.
    Lumateperone: (Moderate) Cabergoline should not be coadministered with lumateperone due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of lumateperone may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as lumateperone.
    Lurasidone: (Moderate) Cabergoline should not be coadministered with lurasidone due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of lurasidone may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as lurasidone.
    Mecamylamine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including mecamylamine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Meperidine; Promethazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Mesoridazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Methyclothiazide: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Methyldopa: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including methyldopa. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. In addition, the prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as methyldopa. Monitor for reduced response to cabergoline.
    Methylergonovine: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Methysergide: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Metoclopramide: (Moderate) Cabergoline should not be coadministered with metoclopramide. The prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as metoclopramide. Metoclopramide increases prolactin levels through central dopamine blockade while cabergoline decreases prolactin levels through dopamine agonist effects.
    Metolazone: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Metoprolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Minoxidil: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including minoxidil. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Moexipril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Molindone: (Moderate) Cabergoline should not be coadministered with molindone due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of molindone may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as molindone.
    Nadolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Naratriptan: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.
    Nebivolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Nebivolol; Valsartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Nicardipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including nicardipine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Nifedipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including nifedipine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Nisoldipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including nisoldipine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Nitrates: (Moderate) Cabergoline should be used cautiously with drugs that can lower blood pressure, including systemic nitrates. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Nitroglycerin: (Moderate) Cabergoline should be used cautiously with drugs that can lower blood pressure, including systemic nitrates. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Nitroprusside: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including sodium nitroprusside. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Olanzapine: (Moderate) Cabergoline should not be coadministered with olanzapine due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of olanzapine may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as olanzapine.
    Olanzapine; Fluoxetine: (Moderate) Cabergoline should not be coadministered with olanzapine due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of olanzapine may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as olanzapine.
    Olanzapine; Samidorphan: (Moderate) Cabergoline should not be coadministered with olanzapine due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of olanzapine may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as olanzapine.
    Olmesartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Olmesartan; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Paliperidone: (Moderate) Cabergoline should not be coadministered with paliperidone due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of paliperidone may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as paliperidone.
    Penbutolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Pergolide: (Moderate) Cabergoline is an ergot derivative that has been associated with valvulopathy and fibrosis; the risk may increase with chronic. prolonged use. Cabergoline should be used with caution in patients exposed to other medications associated with valvulopathy and fibrosis, such as ergot alkaloids. Monitor patients taking these drugs for possible signs and symptoms, which may include dyspnea, persistent cough, chest pain, heart failure, renal insufficiency, or urethral/abdominal obstruction.
    Perindopril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Perindopril; Amlodipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Perphenazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Perphenazine; Amitriptyline: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Phenothiazines: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Phenoxybenzamine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including alpha-blockers. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Phentolamine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including alpha-blockers. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Pimozide: (Moderate) Cabergoline should not be coadministered with pimozide due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of pimozide may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as pimozide.
    Pindolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Potassium-sparing diuretics: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including potassium-sparing diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Prazosin: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including alpha-blockers. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Prochlorperazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Promethazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Promethazine; Dextromethorphan: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Promethazine; Phenylephrine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Propranolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Quetiapine: (Moderate) Cabergoline should not be coadministered with quetiapine due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of quetiapine may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as quetiapine.
    Quinapril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Ramelteon: (Moderate) Cabergoline should not be coadministered with ramelteon, if possible. The prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as ramelteon.
    Ramipril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Reserpine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including reserpine. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. In addition, the prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as reserpine. Monitor for decreased response to cabergoline.
    Risperidone: (Moderate) Cabergoline should not be coadministered with risperidone due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of risperidone may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as risperidone.
    Rizatriptan: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.
    Sacubitril; Valsartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Serotonin-Receptor Agonists: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.
    Sotalol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Spironolactone: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including potassium-sparing diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Spironolactone; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including potassium-sparing diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Sumatriptan: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.
    Sumatriptan; Naproxen: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.
    Telmisartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Telmisartan; Amlodipine: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including amlodipine. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Telmisartan; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Terazosin: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including alpha-blockers. Cabergoline has been associated with hypotension. Initial doses higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Tetrabenazine: (Moderate) Cabergoline should not be coadministered with tetrabenazine, if possible. The prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as tetrabenazine.
    Thiazide diuretics: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Thiethylperazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Thioridazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Thiothixene: (Moderate) Cabergoline should not be coadministered with thiothixene due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of thiothixene may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as thiothixene.
    Timolol: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including beta-blockers. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Tobacco: (Minor) In theory, concurrent use of vasoconstrictors, such as nicotine, with cabergoline may result in enhanced vasoconstriction. Nicotine acts indirectly as a sympathomimetic agent by releasing catecholamines, potentially resulting in effects such as hypertension, which may be additive with ergot derivatives such as cabergoline. Use of the ergot derivative bromocriptine with some sympathomimetics has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm. Caution is advisable during use of tobacco or other nicotine-containing products while taking cabergoline.
    Torsemide: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including loop diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Trandolapril: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Trandolapril; Verapamil: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin-converting enzyme inhibitors. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including verapamil. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. In addition, the prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as verapamil. Monitor for reduced response to cabergoline.
    Triamterene: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including potassium-sparing diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Triamterene; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including potassium-sparing diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Trifluoperazine: (Moderate) Cabergoline should generally not be coadministered with phenothiazines due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of phenothiazines may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as phenothiazines.
    Valbenazine: (Moderate) Cabergoline should not be coadministered with valbenazine, if possible. The prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as valbenazine.
    Valsartan: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Valsartan; Hydrochlorothiazide, HCTZ: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including angiotensin II receptor antagonists. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including thiazide diuretics. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure.
    Verapamil: (Moderate) Cabergoline should be used cautiously with antihypertensive agents, including verapamil. Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. In addition, the prolactin-lowering effect of cabergoline may be diminished by medications that increase prolactin levels such as verapamil. Monitor for reduced response to cabergoline.
    Ziprasidone: (Moderate) Cabergoline should not be coadministered with ziprasidone due to mutually antagonistic effects on dopaminergic function. The dopamine antagonist action of ziprasidone may diminish the prolactin-lowering ability of cabergoline while the dopamine agonist effects of cabergoline may exacerbate a psychotic disorder, reducing the effectiveness of antipsychotics such as ziprasidone.
    Zolmitriptan: (Major) When possible, avoid concomitant use of serotonin-receptor agonists (triptans) within 24 hours of cabergoline administration to minimize the risk for serious coronary ischemia. Ergot alkaloids have been reported to cause prolonged vasospastic reactions which may be additive with the effects of triptans. The risk for vasospastic adverse reactions may be less with cabergoline, a semisynthetic ergot alkaloid derivative, than with other ergot alkaloids as cabergoline is a relatively selective dopamine agonist. In select patients, the combination of cabergoline and "triptans" has been utilized in the management of some headache types, but more data are needed regarding safety and efficacy.

    PREGNANCY AND LACTATION

    Pregnancy

    Although the available data suggest a low fetal risk in early pregnancy, the risk to the developing fetus during chronic cabergoline exposure is unknown. Therefore, cabergoline should be used during pregnancy only if clearly needed. Dopamine agonists, like cabergoline, should generally not be used in patients with pregnancy-induced hypertension (e.g., preeclampsia, eclampsia, or postpartum hypertension), unless the potential benefit is judged to outweigh the possible risk. There is an association of use of these drugs with hypertension, seizures, myocardial infarction, and stroke in postpartum patients. In one review of over 200 pregnancies in cabergoline-exposed women, no increased miscarriage rates, congenital malformations, abnormal distribution of birthweights, or disturbances in postnatal development were noted in comparison to the expected population rate. The range of embryo-fetal exposure to cabergoline was between 1 and 144 days. Among 56 women receiving cabergoline for amenorrhea secondary to hyperprolactinemia, the following outcomes were reported in 17 subsequent pregnancies: 1 spontaneous abortion, 6 pending outcomes, and 10 term infants with normal physical and mental development. In a separate group of women receiving cabergoline for hyperprolactinemia, the following outcomes were reported in 61 pregnancies: 5 elective abortions (1 suspected malformation), 6 spontaneous abortions, 1 hydatidiform mole, and 49 live births (1 minor defect and 1 trisomy). In one study enrolling 47 hyperprolactinemic females, 9 became pregnant against medical advice. Treatment with cabergoline was interrupted when pregnancy was diagnosed. The pregnancy outcomes included 1 voluntary termination, 1 spontaneous termination, and 7 healthy term infants showing normal development during 8 years of continued follow-up. One case describes a patient with two separate pregnancies and the use of levodopa and cabergoline for Parkinson's disease throughout the pregnancies. There were no fetal complications; however, C-section was required in the second birth due to placental abruption. Instruct patients to notify their physician if they suspect they are pregnant, become pregnant, or intend to become pregnant during therapy. Cabergoline treatment in a patient with infertility due to hyperprolactinemia may restore fertility. Conduct pregnancy testing if there is any suspicion of pregnancy.

    MECHANISM OF ACTION

    Cabergoline is a centrally-acting synthetic ergot alkaloid. Cabergoline causes a dose-dependent suppression of prolactin levels via dopamine agonist activity at dopamine-2 (D2) receptors in the anterior pituitary. Stimulation of D2 receptors in this region of the brain inhibits prolactin secretion by lactotrophs. Cabergoline is 7-times more selective for D2 receptors than bromocriptine. The relative selectivity of cabergoline may account for its favorable tolerability profile compared to other dopamine agonists such as bromocriptine. There is minimal affinity for adrenergic, serotonin, or histamine receptors. Cabergoline has little or no effect on the secretion of pituitary hormones such as cortisol, GH, FSH, LH, ACTH, or TSH. Symptoms that may be corrected by the normalization of prolactin levels include loss of libido, amenorrhea, infertility, galactorrhea, gynecomastia, and impotence.

    PHARMACOKINETICS

    Cabergoline is administered orally. Cabergoline is moderately bound (40% to 42%) to human plasma proteins in a concentration-independent manner. In animals, based on total radioactivity, cabergoline (and/or its metabolites) has shown extensive tissue distribution. A considerable amount of the drug may be found in the pituitary as compared with the plasma. Radioactivity in the pituitary exceeded that in plasma by more than 100-fold and was eliminated with a half-life of approximately 60 hours. This finding is consistent with the long-lasting prolactin-lowering effect of the drug. Significant radioactivity (parent plus metabolites) detected in the milk of lactating rats suggests a potential for exposure to nursing infants. A significant fraction of the administered oral dose undergoes a first-pass effect. In both animals and humans, cabergoline is extensively metabolized, predominately via hydrolysis and cytochrome P450 mediated metabolism appears to be minimal. Hydrolysis of the acylurea or urea moiety abolishes the prolactin-lowering effect of cabergoline. None of the major metabolites identified contribute to the therapeutic effect of the drug. The average elimination half-life is 63 to 69 hours. Cabergoline and its metabolites are eliminated primarily in the feces. After the administration of radioactive cabergoline to five healthy volunteers, approximately 60% of the dose was excreted in the feces, and approximately 22% of the dose was excreted in the urine within 20 days. Less than 4% of the dose was excreted unchanged in the urine. Nonrenal and renal clearances for cabergoline are about 3.2 L/minute and 0.08 L/minute, respectively.
     
    Affected cytochrome P450 (CYP450) isoenzymes and drug transporters: None
    CYP450 metabolism of cabergoline is minimal and cabergoline does not cause enzyme induction and/or inhibition in the rat.

    Oral Route

    After oral administration, peak plasma concentrations occur in 1 to 3 hours. The absolute bioavailability of cabergoline is unknown, and the rate and extent of absorption are not affected by food. A significant fraction of the administered oral dose undergoes a first-pass effect. After a once-weekly dosing schedule, steady-state concentrations are expected to be 2- to 3-fold higher than after a single dose. Higher doses produce prolactin suppression in a greater proportion of patients. Also, higher doses are associated with an earlier onset and longer duration of prolactin inhibition. In 12 healthy volunteers, complete prolactin inhibition was obtained in 50% of subjects after a 0.5 mg dose, in 92% after a 1 mg dose, and in 100% after a 1.5 mg dose. Single or multiple doses up to 2 mg in healthy patients had no apparent effect on other anterior pituitary hormones such as growth hormone (GH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), adrenocorticotropin hormone (ACTH), or cortisol. Among 51 hyperprolactinemic patients who received a single 0.6 mg dose, the duration of effect was 14 days, and the time to maximal effect was 48 hours. In contrast, after a single bromocriptine 2.5 mg dose, the duration of effect was 24 hours, and the time to maximal effect was 6 hours. The prolonged prolactin-lowering effect of cabergoline may be related to its slow elimination and long half-life.