Dostinex: Effective Prolactin Regulation Therapy
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Synonyms | |||
Dostinex (cabergoline) is a prescription medication specifically formulated for the treatment of hyperprolactinemia, a condition characterized by abnormally high levels of the hormone prolactin. As a dopamine receptor agonist, it directly targets the underlying physiological mechanism responsible for excessive prolactin secretion. This medication is recognized for its high specificity, long duration of action, and favorable tolerability profile in appropriate patient populations. Clinical use is supported by extensive research demonstrating its efficacy in normalizing prolactin levels and resolving associated symptoms.
Features
- Active ingredient: Cabergoline
- Pharmacological class: Dopamine D2 receptor agonist
- Administration: Oral tablet
- Available strengths: 0.5 mg
- Half-life: Approximately 63-69 hours
- Manufacturer: Pfizer Pharmaceuticals
- FDA approval status: Approved for hyperprolactinemia
Benefits
- Effectively reduces elevated prolactin levels to within normal physiological range
- Restores normal ovarian/testicular function and fertility in most patients
- Alleviates symptoms associated with hyperprolactinemia including galactorrhea
- May reduce prolactinoma size in patients with pituitary tumors
- Long half-life allows for convenient twice-weekly dosing in most cases
- Generally well-tolerated with side effects typically diminishing over time
Common use
Dostinex is primarily indicated for the treatment of hyperprolactinemic disorders, whether idiopathic or due to pituitary adenomas (prolactinomas). It is commonly prescribed for both microprolactinomas and macroprolactinomas. The medication addresses various manifestations of hyperprolactinemia including menstrual irregularities, infertility, hypogonadism, and galactorrhea. Off-label uses may include Parkinson’s disease treatment at higher doses, though this application requires careful specialist supervision due to different risk profiles.
Dosage and direction
The initial recommended dosage is 0.25 mg twice weekly, which may be increased gradually by 0.25 mg twice weekly at 4-week intervals until optimal therapeutic response is achieved. The therapeutic dosage typically ranges from 0.5 mg to 2 mg per week, administered in divided doses. Maximum dosage should not exceed 4.5 mg per week. Tablets should be taken orally with food to minimize potential gastrointestinal discomfort. Dosage adjustments are based on regular monitoring of prolactin levels, typically every 4 weeks during titration phase.
Precautions
Patients should undergo comprehensive cardiovascular evaluation before initiation, including echocardiogram if indicated. Regular monitoring of blood pressure is recommended, particularly during dosage titration. Caution is advised in patients with hepatic impairment, requiring possible dosage adjustment. Patients should be advised about potential dizziness or drowsiness that may impair operating machinery or driving. Abrupt discontinuation should be avoided; gradual tapering is recommended under medical supervision.
Contraindications
Dostinex is contraindicated in patients with hypersensitivity to cabergoline or any ergot derivatives. It should not be used in patients with uncontrolled hypertension, history of cardiac valvular disorders, or pulmonary fibrosis. Contraindication applies to patients with pericarditis or history of fibrotic disorders. Concomitant use with other dopamine antagonists is generally contraindicated due to potential mutual antagonism of therapeutic effects.
Possible side effects
Common side effects (≥1%) include nausea, headache, dizziness, fatigue, and abdominal pain. Less frequent adverse effects may include orthostatic hypotension, constipation, and dyspepsia. Serious but rare side effects include cardiac valvular fibrosis, pleural effusion, and psychiatric disturbances including impulse control disorders. Most side effects are dose-dependent and often diminish with continued therapy or dosage adjustment.
Drug interaction
Significant interactions occur with dopamine antagonists (phenothiazines, butyrophenones, metoclopramide) which may diminish therapeutic efficacy. Concomitant use with macrolide antibiotics may increase cabergoline concentrations. Caution is advised with antihypertensive medications due to additive hypotensive effects. Interaction with serotonin agonists may theoretically increase risk of serotonin syndrome, though clinical evidence is limited.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling of doses to compensate for missed doses is not recommended. Patients should maintain their established twice-weekly schedule without significant alteration.
Overdose
Symptoms of overdose may include severe nausea, vomiting, hypotension, and psychiatric manifestations. Management involves supportive care including gastric lavage if presented early and appropriate symptomatic treatment. Hemodialysis is not expected to be effective due to extensive protein binding. Cardiovascular monitoring is essential in cases of significant overdose.
Storage
Store at room temperature (15-30°C or 59-86°F) in original container. Protect from light and moisture. Keep tightly closed and out of reach of children. Do not use beyond expiration date printed on packaging. Proper disposal of unused medication should follow local regulations for pharmaceutical waste.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient assessment. Patients should not alter dosage or discontinue medication without consulting their prescribing physician. Full prescribing information should be reviewed before initiation of therapy.
Reviews
Clinical studies demonstrate 80-90% normalization of prolactin levels in patients with microprolactinomas and 70-80% in macroprolactinomas. Patient-reported outcomes indicate significant improvement in quality of life measures related to symptom resolution. Long-term studies show maintained efficacy with continuous therapy over several years. Specialist consensus supports Dostinex as first-line therapy for hyperprolactinemia management in appropriate candidates.